SSA-3375 Function Report-Child Birth to 1st Birthday
Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)
SSA-3375-BK
Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday), 20 CFR 416.912 and 416.924a(a)(2)
OMB: 0960-0542
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0542 can be found here: