Form SSA-3377-BK. Function Report - Child Age 3 to 6th Birthday
Form SSA-3377-BK, the Function Report for Children from Age 3 to 6th 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 3 and their 6th b
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 birt
Form SSA-3379-BK. Function Report - Child Age 12 to 18th Birthday
Form SSA-3379-BK, the Function Report for Children Age 12 to 18th Birthday, is 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 12 and their 18th birthday.
Form SSA-3380-BK. Function Report - Adult - Third Party Form
Form SSA-3380-BK, the Function Report for Adults - Third Party Form, is used by individuals or organizations who have knowledge of an adult's daily activities and limitations.
Form SSA-3441-BK. Disability Report - Appeal
Form SSA-3441-BK, the Disability Report - Appeal, is a form used by individuals who wish to appeal the SSA's decision regarding their disability benefits.
Form SSA-3820-BK. Disability Report - Child
Form SSA-3820-BK, the Disability Report for Children, serves as a report for parents or guardians to provide detailed information about a child's disability or medical condition.
Form SSA-3830. Certification of Low Birth Weight for SSI Eligibility
Form SSA-3830, the Certification of Low Birth Weight for SSI Eligibility, is used to certify the low birth weight of a child for eligibility for Supplemental Security Income (SSI) benefits.
Form SSA-3881-BK. Questionnaire for Children Claiming SSI Benefits
Form SSA-3881-BK, the Questionnaire for Children Claiming SSI Benefits, is a questionnaire for parents or guardians of children claiming Supplemental Security Income (SSI) benefits.
Form SSA-3885. Government Pension Questionnaire
Form SSA-3885, the Government Pension Questionnaire, is used to collect information about government pensions received by individuals who are claiming Social Security benefits.
Form SSA-4111. Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits
Form SSA-4111, the Certification of Election for Reduced Widow(er)'s and Surviving Divorced Spouse's Benefits, serves as a certification form for individuals who are eligible for widow(er)'s or surviving divorced spouse's benefits but choose to receive a reduced benefit amount.