Form SSA-3377-BK Function Report - Child Age 3 to 6th Birthday - Feb 2022

The form documents contacts with claimants, beneficiaries, and others during SSA's work. It is maintained in the records system entitled ‘‘Contact and Interview Reports—SSA, SSA/OEEAS 90-0056’’. The form requires information about the contact, including the date, time, location, and purpose of the communication, as well as the names and contact information of those involved.

Social Security Administration employees.

The completed Form SSA-3377-BK Function Report - Child Age 3 to 6th Birthday should be submitted to the Social Security Administration.