Ssa 3379 bk-2025

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The document is a Function Report (Form SSA-3379-BK) used by the Social Security Administration to assess the impact of a child's disabilities on their daily activities and functioning. It provides instructions for completing the form, emphasizes the importance of detailed responses, and outlines how the information will be used to determine eligibility for benefits. The form includes sections for identifying information, functional limitations in various areas such as communication, physical abilities, social interactions, personal care, and attention span.

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Click ‘Get Form’ to open the SSA 3379 BK in the editor.
Begin by filling out Section 1, Identifying Information. Enter the child's name, Social Security number, date of birth, and your relationship to the child. Ensure all details are accurate.
Move to Section 2, Function Details. Answer questions regarding the child's abilities in areas such as seeing, hearing, and communication. For each question, select 'Yes' or 'No' and provide explanations where necessary.
Utilize the 'REMARKS' section for any additional information that may help clarify your answers or provide further context about the child's daily activities and limitations.
Once completed, review all entries for accuracy before saving your document. You can easily export it directly from our platform for submission.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (31 Votes)
2017	4.8 Satisfied (71 Votes)
2003	4.4 Satisfied (122 Votes)
1995	4.4 Satisfied (285 Votes)

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