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Child Disability Report

A Child Disability Report is the application that is filled out for a child who is applying for Social Security Disability benefits under Supplemental Security Income (SSI). In addition the written report, you will be required to make an appointment, either by telephone or in person, to complete your child’s application for SSI benefits. The information needed to determine if your child is eligible for Social Security Disability benefits is quite detailed.

The Child Disability Report requests the following information:

Information about the child:

  • Child’s name, address, and Social Security number
  • Your contact information and your relationship to the child
  • Whether you speak English, and, if not, the person you want Social Security to contact on your behalf
  • What language(s) the child speaks
  • The child’s height and weight
  • Whether the child has a medical assistance card

Contact information:

  • information about the child’s legal guardian and other caretakers

The child’s illnesses, injuries, and conditions and how they affect him or her:

  • The child’s illnesses, injuries, and/or medical conditions
  • The date he or she became disabled
  • Whether the child’s conditions or injuries case symptoms such as pain

Information about the child’s medical records:

  • Name and contact information for each doctor, HMO, therapist, or other medical Professional who sees or has seen the child
  • The date of the first visit, the last visit, and any upcoming appointment
  • Child’s patient ID
  • Reason for each visit and treatment received at the visit
  • Name and contact information for each hospital, clinic, or other treatment facility
  • Information concerning each inpatient, outpatient, or emergency visit, including dates, reason for the visit, and doctors seen
  • Name and contact information for anyone else who would have the child’s medical records, such as foster parents, social workers, counselors, tutors, school nurses, detention centers, attorneys, insurance companies, and/or Worker's Compensation

Medications:

  • Name of each medicine the child takes
  • Name and contact information for the doctor who prescribed each medicine and the reason it was prescribed
  • All side effects from the medicine

Medical tests: Various tests are listed in this section. If the child has had tests other than those listed, you will add them and the other information in Section 10, Remarks.

For each test:

  • Indicate the date an applicable test was performed (including upcoming tests)
  • Where the test was or will be performed
  • The person ordering the test

Additional Information:If the child has been tested or examined by someone with Head Start, a public or community health department, a child welfare or social service agency or WIC, early intervention services, a program for children with special health care needs, a Mental Health/Mental Retardation Center or a vocational rehabilitation center or other employment support services agency, provide:

  • Contact information
  • Type of test
  • Date the test was performed

Education: If the child is not attending school, explain why and give dates last attended. If the child is or has attended school, provide the following information for each school attended in the last 12 months, including day care and pre-school:

  • Contact information
  • Dates attended
  • Grade level
  • Name of teacher
  • Whether the child has been tested for behavioral or learning problems
  • Name of the test given
  • Date it was performed
  • Whether the child is in special education
  • Name of special education teacher
  • Whether the child is in speech therapy
  • Name of speech therapy teacher

Work history: If the child has ever worked, including sheltered work, provide:

  • Dates worked
  • Name and address of employer
  • Name of supervisor
  • Description of work
  • Any problems the child may have had

Date of application and remarks:

  • Date you are applying
  • Any additional remarks you wish to include about the child

In addition to the information described above, bring with you to the appointment:

  • An original or certified copy of the child's birth certificate or proof of U.S. citizenship or legal residency.
  • A list of the full legal names and Social Security Numbers for every person living in the child’s household.
  • Information about your income and assets and about your child’s income and assets. Helpful documents include pay stubs, self-employment tax returns, unemployment or other program benefits, and child support.

You will need this information because Social Security Disability benefits under SSI are provided only for those with very limited income and resources. If your child is under 18, a portion of your income and the value of your assets will be counted toward the income limits. If you child is age 18 or older, their own income and assets are the determining factors. The following article further discusses the income limits for SSI.

While you don’t necessarily need to have all of the aforementioned information available at the time of initial application, assembling and presenting all or most of the necessary documentation can ensure that your application for Social Security Disability benefits under SSI will move forward quickly. Because SSI applications are so detailed and require so many medical records, many people hire a qualified Social Security Disability lawyer or another Social Security Disability professional familiar with applying for Social Security Disability benefits to assist them with their applications.