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Form Page 1 of 11 OMB No 0960-0542 Function Report

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The document is a Function Report (Form SSA-3375-BK) used by the Social Security Administration to gather information about a child's disabilities and how they affect daily activities from birth to their first birthday. It includes instructions for completion, privacy information, and sections for identifying the child and detailing their functional abilities, including vision and hearing issues, as well as developmental milestones.

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What is a function report form?

The SSA uses the Function Report to determine an individuals eligibility for disability benefits. This ten-page report provides detailed information about your functional abilities and ability to perform daily living activities. For example, youre ability to walk, dress, eat, and bathe.

What is a function report for SSI child?

The Function Report - Child (FRC) forms (SSA-3375 through SSA-3379) are used in child cases to obtain functional information from the applicant, and from other caregivers. The FRC forms replace all other forms used to obtain similar information from sources such as a childs parents.

Why did Social Security send me a 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.

How do I answer a disability question?

Answer the questions truthfully. So its important to answer the questions as truthfully as possible. This is not to say, however, that you should downplay your condition. If youre having a hard time climbing even just three flights of stairs or lifting a glass of water, you should indicate such in your answers.

How do you answer Question 7 on a function report?

Questions 7 and 8 Section 7 and 8 of the Adult Function Report ask whether you take care of anyone else, either humans or animals. The SSA asks about whether you care for others because this is an ability that suggests you might not need to file a disability claim. It is important to be honest if you care for others.

How do you explain daily activities at a disability hearing?

You should describe specific examples of how youre limitedphysically, mentally, or bothin your daily activities. Also, be sure to mention your difficulties with daily activities to your doctor, so that they become part of your medical record.

How do you answer a disability function report question?

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 disability 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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