DI 25235.040 Referrals of Title XVI Disabled Children to Designated Title V or Other Agency

A. Referral of title XVI child applicants

The disability determination service (DDS) will refer all allowed blind and disabled children under age 16 to the agency administering the State program under Title V of the Social Security Act or other agency designated by the State for social, developmental, educational, medical, and rehabilitative services.

B. Procedure for referring title XVI children to designated State agency

The DDS will use the SSA-3661-U2 (Transmittal of Title XVI Referral to Designated State Agency) to transmit the referral to the designated title V or other State Agency.

1. Completion of the SSA-3661-U2

The DDS will complete items 1 - 13 of the SSA-3661-U2:

SSA-3661-U2

Item	Explanation
1	Enter the name and address of the appropriate designated State Agency.
2	Enter the child's SSN.
3	Enter the child's name.
4	Enter the child's date of birth.
5	Check "M" or "F."
6	Enter the three-digit DDS Code.
7	Enter the child's full address.
8	Check "A."
9	Enter the full name and relationship of the adult responsible for the child.
10	Enter the responsible adult's address.
11	Enter any special information you feel the designated State Agency might find useful.
12	Leave blank.
13	Enter the date of the referral.
15 - 18	To be completed by the designated State Agency. [The designated State Agency uses these blocks to notify SSA when it determines that the child's impairment(s) has diminished to the extent that it may no longer be disabling.]

2. Attachments to the SSA-3661-U2

Attach legible copies of the following material:

•

SSA-1994 (Cover Sheet Confidential Medical Information)
•

SSA-831 (Disability Determination and Transmittal) or SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title XVI)
•

SSA-3820-BK (Disability Report - Child)
•

Current medical reports on the child's primary impairment(s) (generally, reports within the last 12 months)
•

Other useful information

3. Routing the completed SSA-3661-U2

Send the original and copy of form SSA-3661-U2 and any attachments to the designated Title V or other State Agency designated to provide social, developmental, educational, medical, and rehabilitative services.

4. Documenting the referral in SSA systems

Enter the code "C" in the VOC field of the D831 or D833 closure screen in the National Disability Determination Services System (NDDSS).

NOTE:

No entry is made in item 21 of the SSA-831 (Disability Determination and Transmittal) or item 19 of the SSA-832 (Cessation of Disability or Blindness Determination and Transmittal - Title XVI) when a disabled or blind child under age 16 is referred to a designated State Agency.

C. Procedure for advising the designated State agency about title XVI childhood cessations

If the file indicates that the child was previously referred to the designated State Agency and the DDS determines that a child under age 16 is no longer disabled or blind for Title XVI purposes, forward a copy of the SSA-832 (Cessation of Disability or Blindness Determination and Transmittal - Title XVI) to the State agency designated to receive referrals of allowed Title XVI children.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0425235040

DI 25235.040 - Referrals of Title XVI Disabled Children to Designated Title V or Other Agency - 03/11/2020
Batch run: 09/12/2023
Rev:03/11/2020

Program Operations Manual System (POMS)