Form SSA-3375-BK. Function Report - Child Birth to 1st Birthday

Form SSA-3375-BK is the Function Report for Children from Birth to 1st Birthday. The primary purpose of this form is to collect information about a child's development and functioning during their first year of life. It is used by parents or guardians to report on their child's abilities and any impairments or delays in development.

For example, if a child is born with a disability or experiences developmental delays, their parents or guardians may complete this form to provide information to the SSA when applying for Supplemental Security Income (SSI) on the child's behalf. The purpose is to assist the SSA in evaluating the child's eligibility for SSI benefits based on their condition.

The parties involved are parents or guardians of children applying for SSI benefits on behalf of the child and the SSA. The form typically consists of sections related to the child's medical condition, developmental milestones, and the impact of the condition on daily activities. Accurate reporting of the child's abilities and impairments is essential for the SSA to assess eligibility for SSI benefits.