Information Collection

Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms

IC 250960 under ICR 201904-0960-016 · OMB 0960-0542.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0542 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-3375 Function Report - Child Birth to 1st Birthday Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms	Form
Form SSA-3376-BK Function Report - Child Age 1 to 3rd Birthday Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms	Form
Form SSA-3377-BK Function Report - Child Age 3 to 6th Birthday Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms	Form
Form SSA-3378-BK Function Report - Child Age 6 to 12th Birthday Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms	Form
Form SSA-3379-BK Function Report - Child Age 12 to 18th Birthday Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms	Form

Record metadata
IC Title	Function Report - Child (SSA-3375, SSA-3376, SSA-3377, SSA-3378, SSA-3379) - Paper Forms