SSA-3373 (Formerly SSA-3373-BK) 2007 free printable template

Form Approved OMB No. 0960-0681 SOCIAL SECURITY ADMINISTRATION For SSA Use Only Do not write in this box Related SSN Number Holder SECTION A - GENERAL INFORMATION 1. 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...

How to fill out function report 0960 0681

How to fill out function report 0960 0681:

1. Start by entering your personal information, such as your name, social security number, and contact information.
2. Provide details about your current medical condition and any limitations or restrictions it may pose on your ability to work.
3. Describe the tasks or activities you can still perform despite your medical condition, as well as any assistive devices or accommodations you use.
4. Explain any changes in your condition since your last function report, including new symptoms or treatments.
5. Provide information about your medical providers, including their names, contact information, and how often you see them.
6. List any medications you are currently taking, including the dosages and frequency.
7. Include any additional information that you think is relevant to your disability claim.

Who needs function report 0960 0681:

1. Individuals who are applying for or receiving disability benefits from programs such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
2. Those who have a medical condition that affects their ability to work and need to provide evidence of their limitations and restrictions.
3. People who are seeking to have their disability benefits extended or reevaluated based on changes in their medical condition.

• Who needs an SSA-3373-BK Form?
• What is an SSA-3373-BK Form Used for?
• Is an SSA-3373-BK Form Accompanied by Other Forms?
• • What Information Should be Provided in an SSA-3373-BK Form?
  • How do I fill out an SSA-3373-BK Form?
  • Where do I send an SSA-3373-BK Form?

Who needs an SSA-3373-BK Form?

People who want to report their illnesses, conditions or injuries limiting their lives should use this form.

What is an SSA-3373-BK Form Used for?

This form is an essential paper while applying for any kind of benefits from the employer or government. While asking for some aid you will automatically explain how your life is limited and how the requested benefit can help you.

Is an SSA-3373-BK Form Accompanied by Other Forms?

An SSA-3373-BK Form is not accompanied by other forms. It doesn't need any attachments as well. If you lack some space while answering some questions you can use a “REMARKS” section on the leis page of the form.

What Information Should be Provided in an SSA-3373-BK Form?

• Disabled person's name

• Social Security Number

• Phone number

• Habitation information

• How do reported circumstances limit your ability to work

• Information about daily activities

• Information about abilities

• Medicines taken

• Etc

How do I fill out an SSA-3373-BK Form?

You shouldn't leave fields blank. If you are not sure about the answer you should either call a Social Security and ask them for help or simply write “Don't know”. This form doesn't require any special knowledge. This is made for you to fill it out on your own. If either the explanation is asked for or you need to explain the answer, be sure to explain the answer. If you need some more space to answer any question, there's “REMARKS” section on the last page for it. Don't forget to write the number of question being answered while using the “REMARKS” section.
Don't write on the “For SSA Use Only” section.

Where do I send an SSA-3373-BK Form?

It is sent to the establishment which made a request for it.

Instructions and Help about function report 0960 0681

Friends from around the corner around the world welcome to another edition of reality TV as we continue to tell the story of this hard-working disabled American and hopefully a story that resonates with folks in similar situations how we get treated like dirt pounded into nothing is the benefits continue to roll along for irresponsible mothers they continue to have child after child to obtain more benefits the illegal aliens that come into the country obviously illegally to continue to get benefits terrorists as we know from the bombing back in April here in Boston the unfortunate incident that took place they were obtaining benefits we've had individuals going to jail for murder and other crimes trying to get sex changes that the taxpayers pay for and here in the great old state of Massachusetts we have dead people trying to obtain these benefits so is this nonsense continues this despicable way to treat hard-working Americans we continue to tell the story here I have this giant packet that was sent to me, it seems like it's some kind of progress which is a good thing and I have to fill this out to see if I am entitled to be a disabled American as I've noted I received paperwork from my doctor and yeah for my doctor as far as receiving disability placard for an automobile disability MTA pass if you're out of Massachusetts that's the public transportation system I'm working to get IMS Health as I can't even see a doctor right now even with the plethora of issues with my neck back and feet but what I'm going to do is to try and show you what exactly you have to go through if you are an unfortunate disabled American to try and get benefits that you've paid taxes years and years and years and years into I'm going to fill it out on this very program I don't know how long it's going to take, but we are going to do so this is going to be mailed to London Kentucky to a lovely lady named Eunice Newton all right let's see these are just some bay basic instructions we're going to make a DVD of this and include it to Mrs. Newton because we like folks to see what we're doing here on reality TV we've got quite the response from Melrose Wakefield Hospital as far as them feeling they did an appropriate job in my visits to the emergency room there which questions what they consider to be quality and what they consider to be appropriate let's see well a lot of notes all right my daytime telephone number I don't think anyone needs this, so I'll just fill that out I have my trusty assistant Afro-American who's been an MVP here all summer long especially we're going to give him a hell of a letter recommendation if he decides to go on to college once he leaves high school — upowhomho do I live with Emily describe what you do from the time you wake up until going to bed I could really have some fun with that one but let's see I wake up in severe pain I take several medications struggling to stay awake I struggle to get to the bathroom in groom what else do I do every...

People Also Ask about function report 0960 0681

How do you answer Question 6 on a function report?

Question 6: Describe what you do from the time you wake up until going to bed. When I ask many of my clients this question, they'll often answer, “not much.” However, you are always doing something. When you file a disability claim, you need to provide specific details.

What happens after function report is sent into SSDI Dept?

They will use the information you provide to help them decide whether or not your disability qualifies under their definitions and standards for disability benefits. They may also ask that your doctor fill out a similar form to help confirm your condition and abilities.

What is the continuing disability review function report?

The SSA-454-BK (Continuing Disability Review Report) collects information necessary for a CDR and expedited reinstatement (EXR) case. The report records the most current information about the disabled individual's condition since the most recent favorable medical decision or the comparison point decision (CPD).

How do you answer question 6 on a function report?

Question 6: Describe what you do from the time you wake up until going to bed. When I ask many of my clients this question, they'll often answer, “not much.” However, you are always doing something. When you file a disability claim, you need to provide specific details.

How to fill out Social Security Disability Function Report?

9 tips for filling out the function report Keep your answers consistent. Start with question 20. Answer questions directly. Talk about your average or worst days. Be honest and don't exaggerate. Send additional information as quickly as possible. Talk about all conditions that keep you from working.

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