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- Click ‘Get Form’ to open the 3379 form in the editor.
- Begin by filling out Section 1, which includes identifying information about the child. Enter the child's name, Social Security number, date of birth, and your relationship to the child.
- Proceed to Section 2, where you will answer questions regarding the child's functional abilities. For each question, select 'Yes' or 'No' and provide explanations as needed.
- Utilize the 'REMARKS' section for any additional comments or clarifications that may help in understanding the child's situation better.
- Once completed, review all entries for accuracy before saving or sending the form directly from our platform.
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Related links
Form SSA-3379-BK (01-2022) UF. Discontinue Prior Editions. Social Security Administration. FUNCTION REPORT - CHILD. AGE 12 TO 18th BIRTHDAY. Page 3 of 11.
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Use this form to report potential tobacco-related violations of the Federal Food, Drug, and Cosmetic Act and associated regulations.