PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form SSA-3375-BK
for the current year.
Form SSA-3375-BK Function Report - Child Birth to 1st Birthday
What Is Form SSA-3375-BK?
This is a legal form that was released by the U.S. Social Security Administration on February 1, 2015 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-3375-BK?A: Form SSA-3375-BK is a function report for documenting a child's development from birth to their first birthday.
Q: What is the purpose of Form SSA-3375-BK?A: The purpose of Form SSA-3375-BK is to gather information about a child's abilities, limitations, and daily activities during their first year of life.
Q: Who needs to fill out Form SSA-3375-BK?A: The child's parent or caregiver needs to fill out Form SSA-3375-BK.
Q: What information is required on Form SSA-3375-BK?A: Form SSA-3375-BK asks for information about the child's medical conditions, developmental milestones, daily activities, and any assistance or therapy they receive.
Q: Are there any deadlines for submitting Form SSA-3375-BK?A: The SSA recommends submitting Form SSA-3375-BK as soon as possible after the child's first birthday. However, it can still be submitted up to 14 months after the child's first birthday.
Q: What should I do if I need help filling out Form SSA-3375-BK?A: If you need help, you can contact your local SSA office or consult with a representative from the SSA.
Q: Is there a fee for submitting Form SSA-3375-BK?A: No, there is no fee for submitting Form SSA-3375-BK.
Form Details:
- Released on February 1, 2015;
- 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-3375-BK by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.
Download Form SSA-3375-BK Function Report - Child Birth to 1st Birthday
1
2
3
4
5
6
7
