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Get SSA-3379-BK 2003

N that you give us on this form will be used by the office that makes the disability decision on the child's claim. You can help them by completing as much of the form as you can. Print or type. Do not ask a doctor or hospital to complete this form. Be sure to explain your answer if an explanation is requested or needed. If more space is needed to answer any of the questions, please use the "REMARKS" section and show the number of the question being answered. The information we ask for on this .

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