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SSA-3379-BK Function Report - Child Age 12 to 18th Birthday-2026
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Definition and Purpose of the SSA-3379-BK Form
The SSA-3379-BK Function Report is a vital document employed by the Social Security Administration (SSA) to evaluate how disabilities impact the daily activities of children aged 12 to 18. This report aids in understanding how a child's limitations affect various aspects of their life, which is crucial for determining eligibility for Social Security benefits. The form requires comprehensive information on the child's ability to communicate, engage in social interactions, manage personal care, and perform physical activities.
How to Use the SSA-3379-BK Function Report
The purpose of this form is to gather detailed insights into the child's daily functioning. Parents or guardians are instructed to provide thorough responses about the child's limitations and capabilities. The responses should highlight specific challenges the child faces in communication, social interactions, physical tasks, and personal care. It’s essential to include examples and scenarios that illustrate these difficulties to provide the SSA a clear understanding of the child's situation.
Steps to Complete the SSA-3379-BK Function Report
Gather Necessary Information: Collect all relevant data about the child's daily routines, medical history, and any educational or support services they receive.
Complete Each Section: Address all questions in the form, providing detailed responses. Avoid leaving sections blank unless they are not applicable.
Provide Specific Examples: For each area, include specific examples that clearly demonstrate the child’s difficulties and strengths.
Review and Edit: After completing the form, review it for accuracy and completeness. Ensure all relevant information is included, and correct any errors.
Submit the Form: Once finalized, submit the form to the SSA as instructed, either via mail or an online submission platform if available.
Key Elements of the SSA-3379-BK Function Report
Communication Abilities: This section includes a detailed analysis of the child's ability to express and comprehend verbal and non-verbal communication.
Physical Activities: Here, document any physical challenges the child encounters in daily tasks, such as difficulties in walking, climbing, or managing hand-eye coordination.
Social Functioning: This part captures the child’s interactions with peers, family, and other individuals, assessing their ability to maintain relationships.
Personal Care Skills: Details on how the child manages personal hygiene and self-care activities are crucial.
Importance of Completing the SSA-3379-BK Function Report
The completion of this form is crucial for SSA to make informed decisions on the child's eligibility for Supplemental Security Income (SSI) benefits. Accurate representation of the child's abilities ensures that they receive the appropriate level of support and services. It also offers parents and guardians an opportunity to highlight their child's unique challenges and obtain the necessary assistance.
Who Typically Uses the SSA-3379-BK Function Report
This form is primarily used by parents or guardians of children aged 12 to 18 who are applying for SSI due to disabilities. Healthcare providers, educational specialists, and social workers may also assist in providing the necessary information required to comprehensively complete the report.
Required Documents for the SSA-3379-BK Function Report
Medical Records: Include detailed medical history, diagnoses, and treatment plans relevant to the child's condition.
Educational Reports: Any IEP (Individualized Education Plan) or 504 Plan that outlines accommodations provided at school.
Therapy Notes: Documentation from physical, occupational, or speech therapists outlining the child’s progress and ongoing challenges.
Legal Use of the SSA-3379-BK Function Report
This form is legally used to substantiate claims for SSI benefits for children with documented disabilities. The information provided in the form is protected under privacy laws to ensure the confidentiality of the child's and family's personal data. Misrepresentation or falsification of information can have legal consequences, including the denial of benefits.
Examples of Using the SSA-3379-BK Function Report
Case Study 1: A 14-year-old diagnosed with autism spectrum disorder, struggles with social interactions at school, requiring detailed documentation of their daily routine and social challenges for the SSA evaluation.
Case Study 2: A 16-year-old with cerebral palsy, documenting how physical limitations affect their ability to perform tasks like dressing or writing, supported by medical and educational reports.
These examples illustrate the necessity for detailed, individual-centered information that captures the child's unique circumstances and needs.
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What is a third party function report for SSA disability?
Form SSA-3380-BK is a form used by an individual seeking disability benefits from the Social Security Administration. This is a function report for an adult that is completed by a third-party. The third-party chosen to complete this extensive form cannot be a medical professional treating the applicant.
How to answer Social Security disability Function Report?
Be honest but dont exaggerate. Be specific about your limitations. If you do not clearly describe your limitations or give vague answers on your Adult Function Report, Social Security will take that to mean your disability really isnt that bad and you should have no problem returning to work.
How do you answer a function report?
9 tips for filling out the function report Keep your answers consistent. Start with question 20. Answer questions directly. Talk about your average or worst days. Be honest and dont exaggerate. Send additional information as quickly as possible. Talk about all conditions that keep you from working.
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People also ask
Why did I get a function report from SSA?
Why Did Social Security Send Me a Function Report? The Social Security Administration may send you a Function Report form as part of your disability application process. The form ensures the SSA has the most accurate and up-to-date information possible.
What is a child function report?
The information we ask for on this form tells us how you think the childs illnesses or injuries affect the way he or she does many of his or her usual activities.
What is the purpose of function report?
The Function Report (SSA-3373) helps DDS to obtain information about how an applicants illness(es) and condition(s) affect their ability to function and perform everyday tasks.
What is the function report for SSA?
The Adult Function Report is often used by Social Security to discredit your claim. The ten-page form asks about your daily activities, personal care, meal prep, household and yard work, hobbies, and social activities.
What is a third party function report for SSA disability?
Form SSA-3380-BK is a form used by an individual seeking disability benefits from the Social Security Administration. This is a function report for an adult that is completed by a third-party. The third-party chosen to complete this extensive form cannot be a medical professional treating the applicant.
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The information we ask for on this form tells us how you think the childs illnesses or injuries affect the way he or she does many of his or her usual