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Ssa 5666-2026
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- Click ‘Get Form’ to open the SSA 5666 in the editor.
- Begin by entering the claimant's name at the top of the form. This is essential for identifying the child’s records.
- In Section 1, indicate if there has been any recent evaluation or testing of the child. Provide details about the type of tests and dates.
- For Section 2, specify if the child has been referred for assessment or special services, including relevant dates and names.
- Fill out Section 3 with current instructional levels, including scores from standardized assessments for reading, math, and written language.
- In Section 4, check any grades that have been repeated by the child.
- Section 5 requires you to list any educational disabilities. Check all that apply.
- Complete Section 6 by checking applicable placement and related services. Be sure to include hours per week where necessary.
- Use the additional comments section on page 2 for any further information that may assist in evaluating the child's functioning.
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Related links
The Social Security Administration is authorized to collect the information on this form under sections 1614 and 1633 of the Social Security.
REQUEST FOR ADMINISTRATIVE INFORMATION. Please ask the person(s) most familiar with the childs records to complete this form.
For additional information, see Transaction Log. To LED location. Infrared. Printer. (52-2069). Door Name 5666. Seq User Trans.