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FUNCTION REPORT - ADULT - Form SSA-3373-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form, complete as much of it as you can and call the phone number provided on the letter sent with the form, or contact the person who asked you to complete the form. If you need the address or phone number for the office that provided the form, you can get it by calling Social Security at 1-800-772-1213. Function Report - Adult - Form SSA-3373-BK HOW MoreIf you need help with this form, complete as much of it as you can and call the phone number provided on the .... (For example, sandwiches, frozen dinners, or complete .... City. Zip Code. State. -. Page 8. Form SSA-3373-BK (6-2004) ef (07- 2004) Less
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