In addition to the form SSA-454-BK, also complete:
Form SSA-3881-BK (Questionnaire for Children Claiming SSI Benefits). To obtain the
name of someone else who could help SSA obtain evidence about the child, see DI 11005.030B.2.
NOTE: It is extremely important that the FO make every effort to obtain the name of an
“other responsible adult” when completing the form SSA-3881-BK, or to document the
file when no third party is available.
b. The appropriate function report for the child (Function Report—Child Birth to 1st
Birthday SSA-3375-BK, Function Report—Child Age 1 to 3rd Birthday SSA-3376-BK, Function
Report--Child Age 3 to 6th Birthday SSA-3377-BK, Function Report – Child Age 6 to
12th Birthday SSA-3378-BK, or Function Report—Child Age 12 to 18th Birthday, SSA-3379-BK).
NOTE: For FO electronic case procedures, see DI 81010.000.
Advise the payee that he or she may be asked to provide evidence to show that the
child is and has been receiving treatment, to the extent considered medically necessary
and available, for the condition(s) that was the basis for providing benefits. Advise
the payee that, if he or she refuses to comply with this requirement without good
cause, we will decide if benefits should go to another payee, at which time the child’s
record may be placed in administrative suspense until another payee can be found,
or if the child should receive his or her own benefits directly.