Get Ssa-3376-bk 2008-2025

The SSA-3376-BK, also known as the Function Report - Child Age 1 to 3rd Birthday, is a crucial document for assessing a child's functional abilities and needs. This guide will provide you with clear and supportive instructions to help you accurately complete the form online.

Follow the steps to fill out the SSA-3376-BK effectively.

1. Click the ‘Get Form’ button to access the SSA-3376-BK and open it in your preferred online editor.
2. Begin by entering the identifying information in Section 1. Fill in the child's name, social security number, and date of birth accurately. Additionally, provide your name, relationship to the child, date completed, daytime telephone number, and mailing address.
3. Proceed to Section 2 - Function Details. Answer each question regarding the child's capabilities. For example, indicate if the child has problems seeing or hearing, and elaborate on their condition if applicable.
4. For each query, use the options provided and mark all appropriate statements that apply to the child. Include details where necessary to provide comprehensive information.
5. Continue answering the questions pertaining to the child's ability to talk, understand, learn, and interact with others. It is important to indicate any limitations and describe the child's behavior in different contexts.
6. Make sure to utilize the 'REMARKS' section if you need additional space to clarify any of your answers or to provide further insights about the child's functional abilities.
7. Once you have completed all sections, ensure to review your entries for accuracy. You can then save changes, download a copy, print the form, or share it as needed.

Start filling out the SSA-3376-BK online to help ensure the best support for the child's needs.