RMATION Please ask the person(s) most familiar with the child's records to complete this form. Continue any answers as needed on next page. Name of School 1. Has there been any recent evaluation or testing of this child? If yes, kind(s) of test/evaluation: Date(s): Please send us copies of all comprehensive evaluations, triennial assessments, psychological or speech/language testing, current Individualized Education Programs, teacher/therapist progress reports, and all other records that can .
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How to fill out the SSA-5666 online
The SSA-5666 form is essential for requesting administrative information related to a child's evaluation, assessments, and educational services. This guide provides step-by-step instructions to help users fill out the form accurately and efficiently online.
Follow the steps to complete the SSA-5666 form online.
- Press the ‘Get Form’ button to access the SSA-5666 form and open it in your digital editor.
- Begin filling out the form by entering the claimant's name and Social Security Number. Ensure that all information provided is accurate to avoid delays.
- In the section asking if there has been any recent evaluation or testing of the child, answer 'Yes' or 'No.' If 'Yes,' provide details about the type of test and the date(s) it occurred.
- If the child has been referred for assessment or services, provide the name of the individual or organization involved and the dates of referral.
- Complete the current instructional levels section by noting the standardized assessment instruments used. Record the scores or percentile ranks for reading, math, and written language.
- Indicate any grades that the child has repeated by checking the corresponding boxes for the grades K-12.
- List any educational disabilities that apply by selecting from the provided options. Specify any details as necessary.
- In the placement and related services section, check all applicable options for the child's educational environment and support services.
- Utilize the additional comments section for any continuation of answers from previous pages or to provide further information that could assist in evaluating the child's functioning.
- Once you have completed the form, review all entries for accuracy. You can then save your changes, download, print, or share the document as needed.
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