Form SSA3379BK (102017) UF Discontinue Prior Editions Social Security AdministrationPage 1 of 11 OMB No. 09600542Function Report Child Age 12 to 18th Birthday Filling Out The Function Report IF YOU.
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How to fill out the SSA-3379-BK online
Completing the SSA-3379-BK form online can seem overwhelming, but with clear guidance, you can make the process smoother. This form is essential for detailing how a child's disabilities impact their daily activities and functions.
Follow the steps to effectively complete the SSA-3379-BK online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Start with Section 1, which collects identifying information about the child. Input the child's full name, social security number, and date of birth. Next, provide your information as the person completing the form, including your relationship to the child and your contact details.
- Proceed to Section 2, where you will answer questions about the child's functional abilities. For each question about vision, hearing, speech, daily activities, communication, learning, physical abilities, social interactions, personal needs, and task attention, select 'Yes', 'No', or 'Not Sure' as applicable. Be sure to provide explanations in the remarks section if necessary.
- If additional space is required for your answers, utilize the 'REMARKS' section and refer to the related question number to ensure clarity.
- Review all the information entered to confirm its accuracy and completeness. Make any necessary adjustments before proceeding.
- Once everything is filled out, save changes, or download, print, or share the completed form as needed.
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