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This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-3379-BK
for the current year.
Form SSA-3379-BK Function Report - Child Age 12 to 18th Birthday
What Is Form SSA-3379-BK?
This is a legal form that was released by the U.S. Social Security Administration on October 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form SSA-3379-BK?
A: Form SSA-3379-BK is a Function Report used to assess a child's ability to perform daily activities.
Q: Who needs to complete this form?
A: Parents or caretakers of a child between the ages of 12 and 18 need to complete this form.
Q: What is the purpose of this form?
A: The purpose of this form is to evaluate a child's ability to perform daily activities and help determine their eligibility for disability benefits.
Q: What information is requested in this form?
A: This form requests information about the child's daily activities, behavior, self-care, and ability to function in different settings.
Q: What should I include in the form?
A: You should provide detailed information about the child's abilities, limitations, and any assistance they require to perform daily activities.
Form Details:
- Released on October 1, 2017;
- The latest available edition released by the U.S. Social Security Administration;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form SSA-3379-BK by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.
Download Form SSA-3379-BK Function Report - Child Age 12 to 18th Birthday
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