Form Page 1 of 11 OMB No 0960-0542 Function Report-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section 1 - Identifying Information. Enter the child's name, Social Security number, and date of birth. Then, provide your name, relationship to the child, and contact information.
3. Proceed to Section 2 - Function Details. Answer questions regarding the child's vision and hearing abilities. If applicable, mark statements that are true about the child’s condition and provide explanations where necessary.
4. Continue through Section 2 by indicating whether the child's activities or abilities are limited. Mark 'yes' or 'no' for each developmental milestone listed and provide additional explanations in the remarks section if needed.
5. Once all sections are completed, review your entries for accuracy before saving or printing the form directly from our platform.

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