U.S. SSA Form ssa-ssa-5666-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the claimant's name and Social Security Number (SSN) at the top of the form. This information is crucial for identifying the records associated with the child.
3. In Section 1, indicate if there has been any recent evaluation or testing of the child. If yes, provide details about the type of tests and dates.
4. Proceed to Section 2 and specify if the child has been referred for assessment or special services, including relevant dates and names.
5. Fill out Section 3 by providing current instructional levels and scores from standardized assessments for reading, math, and written language.
6. In Section 4, check any grades that have been repeated by the child.
7. Section 5 requires you to list any educational disabilities. Check all that apply and provide specifics where necessary.
8. Complete Section 6 by checking applicable placement and related services, detailing hours per week for therapies if needed.
9. Use the additional comments section for any further information that may assist in evaluating the child's functioning.

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