Teacher questionnaire 2026

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The document is a Teacher Questionnaire (Form SSA-5665-BK) from the Social Security Administration, designed to collect information from teachers or homeschool teachers about a child's functioning in relation to a disability benefits claim. It emphasizes the importance of non-medical observations in assessing a child's eligibility for benefits, clarifies the distinction between educational and Social Security definitions of disability, and provides guidance on completing the form. The questionnaire includes sections on various domains of functioning, such as acquiring information, attending tasks, interacting with others, and self-care.

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Click 'Get Form' to open the teacher questionnaire in the editor.
Begin by entering the name of the school and your relationship with the child. This establishes context for your responses.
In Section 1, provide details about how long you have known the child and how often you see them. This information is crucial for assessing their daily functioning.
Proceed to Section 2, where you will rate the child's abilities in acquiring and using information. Use the provided rating scale to indicate any observed problems compared to peers.
Continue through Sections 3 to 5, which cover attending tasks, interacting with others, and self-care skills. For each section, mark any issues and provide additional comments as needed.
Finally, review your responses for accuracy before submitting. Ensure all relevant sections are completed to provide a comprehensive view of the child's capabilities.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (270 Votes)
2011	4.4 Satisfied (139 Votes)

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