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How do this person s illnesses injuries or conditions limit his/her ability to work Form SSA-3380-BK 12-2009 ef 01-2013 Use 12-2009 Edition Until Supply Exhausted Page 1 9. FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP HOW TO COMPLETE THIS FORM The information that you give on this form will be used to make a decision on the disabled person s claim. You can help by completing as much of the form as...
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How to fill out how to form ssa

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How to fill out SSA-3380-BK

01
Obtain the SSA-3380-BK form from the Social Security Administration website or local office.
02
Read the instructions carefully before beginning to fill out the form.
03
Start with Section 1: Fill out your personal information including name, Social Security number, and date of birth.
04
In Section 2, provide details about your work history, including job titles and dates of employment.
05
Proceed to Section 3: Answer the questions about your medical conditions and how they affect your ability to work.
06
In Section 4, describe the treatments you have received and any medications you are currently taking.
07
Section 5 requires information about your daily activities and how your conditions impact them.
08
Review all your answers for accuracy and completeness.
09
Sign and date the form to certify that the information provided is true to the best of your knowledge.
10
Submit the completed SSA-3380-BK form to your local Social Security office or as instructed.

Who needs SSA-3380-BK?

01
Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits who have a mental impairment.
02
Applicants required to provide detailed information about their mental condition and its impact on daily functioning and work abilities.

Who needs a SSA 3380 bk 2009 form?

The “Function Report – Adult – Third Party” form also known as the ssa 3380 bk form is necessary for Social Security disability clients and their families in applying for and appealing their Social Security disability claim. The ssa 3380 bk 2009 form must be completed by third parties, which indicate the limitations of the disabled person.

What is SSA 3380 bk 2009 form?

The ssa 3380 bk 2009 Adult Function Report form gives information to help determine whether physical limitations of a disabled person are a sufficient reason for assistance provided by the state.

Is SSA 3380 bk 2009 form accompanied by other forms?

This ssa 3380 bk 2009 form is not accompanied by any other forms.

When is SSA 3380 bk 2009 form due?

You can fill out form ssa 3380 bk at any time as needed. Just be sure it complies with the latest requirements for documents posted on the Official Social security website.

How do I fill out SSA 3380 bk 2009 form?

Ssa 3380 bk 2009 form has several pieces to fill out:

  • General information, including the name, contact information, and relationship to the disabled person;
  • Information that describes a typical day of the disabled person, their activity, meals, housework, shopping, interests, etc.;
  • Information about mental and physical condition of the disabled person;
  • Remark section

Where do I send SSA 3380 bk 2009 form?

You need to send this form to the office which requested it. If you don’t have that address, you can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

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SSA-3380-BK is a form used by the Social Security Administration (SSA) to collect detailed information about a person's disability and how it affects their daily life.
Individuals who are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) and need to provide detailed information about their disability are required to file SSA-3380-BK.
To fill out SSA-3380-BK, individuals must provide information about their medical conditions, treatments, daily activities, and the limitations they experience due to their disabilities as prompted by the form's sections.
The purpose of SSA-3380-BK is to gather comprehensive information on a claimant's medical history and daily functioning to assist in the evaluation of their eligibility for disability benefits.
The information that must be reported on SSA-3380-BK includes personal identification details, medical conditions, a list of treatments and medications, descriptions of daily activities, and any limitations or difficulties faced in performing various tasks.
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