Form SSA-3376-BK. Function Report - Child Age 1 to 3rd Birthday

Form SSA-3376-BK is the Function Report for Children from Age 1 to 3rd Birthday. The main purpose of this form is to collect information about a child's development and functioning between their first and third birthdays. It is used by parents or guardians to report on their child's abilities, milestones, and any impairments or delays in development.

For example, if a child has a developmental delay or disability, their parents or guardians may complete this form when applying for SSI benefits 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 and development.

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 crucial for the SSA to assess eligibility for SSI benefits.