SSA-3379 Function Report - Child Age 12 to 18th 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-3379 Revised

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⚠️ Notice: This form may be outdated.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:

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File Title Function Report - Child Age 12 to 18th Birthday
Subject Function Report - Child Age 12 to 18th Birthday, SSA-3379-BK, SSA-3379, 3379, Function Report Child
Author SSA
File Modified 2013-04-03
File Created 2013-03-22

File Type	application/pdf
File Title	Function Report - Child Age 12 to 18th Birthday
Subject	Function Report - Child Age 12 to 18th Birthday, SSA-3379-BK, SSA-3379, 3379, Function Report Child
Author	SSA
File Modified	2013-04-03
File Created	2013-03-22