What You Need to Know About Form SSA 3379

In this article...
  • Discover why the SSA 3379 form is an important part of the Social Security disability application process, and gain valuable tips for completing it correctly.

SSA 3379 is a form used by the Social Security Administration to evaluate the functioning level of children ages 12 – 18. The form is intended for use by a child's parents or legal guardians and not doctors or hospitals. Learn about the SSA 3379 form, why you might need to complete it and gain tips for submitting it to Social Security.

Why Is SSA 3379 Important? 

The SSA 3379 form, also called the SSA 3379-BK form, measures a child’s ability to function physically, mentally and socially. It is an important tool used by Social Security to determine if a child between the ages of 12 and18 qualifies for Social Security disability benefits. Completing this form is a required part of the application process. 

What Questions Does the SSA 3379 Form Ask? 

Because the SSA 3379 form is designed for use by a parent or guardian, the questions are fairly general and do not require medical knowledge to complete. The questions are posed in a yes or no format with more specific questions, also in yes or no format, for every question answered with a “Yes.” 

The form also includes additional lines for explanation and an additional page at the end where you can provide more detail. Sample question topics include: 

  • Basic demographic information
  • Speech and hearing ability
  • Sight ability or limitations
  • Social functioning or limitations
  • Learning comprehension
  • Activities of daily living 

Tips for Completing the SSA 3379 Form 

In some cases, the answers to questions on the SSA 3379 form are your best opportunity to describe your child's behaviors, abilities and limitations. For this reason, it's important to utilize the additional space to provide details or an explanation whenever possible. If you're having trouble answering a question, think about recent events to give a scenario or example of functioning. For instance, if your child has difficulty in social situations, write down feedback teachers have provided or describe specific scenarios that have occurred in the past. 

What If I Need Help With SSA 3379? 

If you need help completing SSA 3379, contact the Social Security office directly. You may be able to speak with a representative or schedule an appointment at your local office for assistance with the form.