Form SSA-3378-BK. Function Report - Child Age 6 to 12th Birthday

Form SSA-3378-BK, the Function Report for Children Age 6 to 12th Birthday, serves as a questionnaire for parents or guardians to provide detailed information about a child's abilities, developmental milestones, and any impairments or delays in development between the ages of 6 and their 12th birthday. The primary purpose of this form is to assist the Social Security Administration (SSA) in evaluating disability claims on behalf of children.

For example, if a child has a developmental delay or disability, their parents or guardians may complete this form when applying for Supplemental Security Income (SSI) benefits on the child's behalf. The purpose is to provide the SSA with a comprehensive account of the child's development and functioning to assess eligibility for SSI benefits.

The parties involved are parents or guardians of children applying for SSI benefits on behalf of the child and the SSA. The form 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.