Disability Applications & Evidence
Form SSA-3375-BK: Function Report - Child Birth to 1st Birthday
Form SSA-3375-BK (Function Report - Child Birth to 1st Birthday) is an official Social Security Administration form commonly used in disability applications & evidence matters. Review SSA’s instructions carefully, use the current version from SSA.gov, and submit it only as SSA directs for your situation.
This page explains what the form is used for and links you to the official document on the Social Security Administration website. Always use the current version from SSA.gov and follow the filing instructions SSA provides for your matter.
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Independent advocacy — official forms belong to SSA
Shaw Social Security Advocacy Services is an independent advocacy service and is not affiliated with, endorsed by, or operated by the Social Security Administration or any other federal government agency. Form SSA-3375-BK is published by the Social Security Administration. Confirm you have the latest version on ssa.gov/forms before filing.
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