Get Ssa-3375-bk 2022-2025

The SSA-3375-BK form, known as the Function Report - Child Birth to 1st Birthday, is essential for assessing disabilities in children. This guide will provide you with comprehensive steps to help you accurately complete this form online.

Follow the steps to complete the SSA-3375-BK online.

1. Click ‘Get Form’ button to access the SSA-3375-BK and open it in the editor.
2. Begin by entering the child's identifying information. Fill in the child's name, Social Security number, and date of birth. Indicate who is completing the form, their relationship to the child, the date the form is completed, and provide a daytime telephone number along with a mailing address.
3. Proceed to section 2, which focuses on function details. Answer whether the child has problems seeing or hearing. For each question, if you respond 'yes', provide additional details in the space provided, explaining the nature of any visual or auditory challenges.
4. Continue in section 2 by assessing the child's activities and abilities. For each activity listed, indicate 'yes' or 'no' based on the child's abilities. If needed, there is space to explain any answers provided.
5. If you have additional comments or explanations, use the remarks section to elaborate on any of the items from section 2 or include other relevant information about the child's condition.
6. After completing the form, review all entries to ensure accuracy. Once you are satisfied with the form, you can save the changes, download the completed form, print it, or share it if necessary.

Complete the SSA-3375-BK online to ensure an accurate assessment of the child's needs.