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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-3378-BK
for the current year.
Form SSA-3378-BK Function Report - Child Age 6 to 12th Birthday
What Is Form SSA-3378-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-3378-BK?
A: Form SSA-3378-BK is a Function Report used for children between the ages of 6 to 12 years old.
Q: What is the purpose of Form SSA-3378-BK?
A: The purpose of Form SSA-3378-BK is to gather information about a child's daily activities, abilities, and limitations in order to evaluate their eligibility for disability benefits.
Q: Who is the form for?
A: The form is for children between the ages of 6 to 12 years old who are applying for disability benefits.
Q: What information is needed on the form?
A: The form asks for information about the child's daily activities, abilities and limitations, education and special education, medical treatment and therapy, and any medications the child is taking.
Q: Do I need to fill out the form for my child's disability application?
A: Yes, as a parent or guardian, you will need to fill out the Form SSA-3378-BK for your child's disability application.
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-3378-BK by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.
Download Form SSA-3378-BK Function Report - Child Age 6 to 12th Birthday
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