PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-3376-BK
for the current year.
Form SSA-3376-BK Function Report - Child Age 1 to 3rd Birthday
What Is Form SSA-3376-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-3376-BK?A: Form SSA-3376-BK is a Function Report used for children aged 1 to 3 years old.
Q: What is the purpose of Form SSA-3376-BK?A: The purpose of Form SSA-3376-BK is to gather information about a child's daily activities, abilities, and limitations.
Q: Who needs to fill out Form SSA-3376-BK?A: Parents or caregivers of a child aged 1 to 3 years old need to fill out Form SSA-3376-BK.
Q: What information is required on Form SSA-3376-BK?A: Form SSA-3376-BK asks for information about the child's daily activities, self-care, and abilities in various domains.
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-3376-BK by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the U.S. Social Security Administration.
Download Form SSA-3376-BK Function Report - Child Age 1 to 3rd Birthday
1
2
3
4
5
6
7
8
9
