SSA-3378-BK 2003 free printable template

Send only comments relating to our time estimate to this address not the completed form. SSA-3378-BK 6-2003 ef 02-2005 Form Approved OMB No. 0960-0542 FUNCTION REPORT - CHILD AGE 6 TO 12th BIRTHDAY SECTION 1 - IDENTIFYING INFORMATION 1. Page 9 SECTION 3 - REMARKS SSA will insert the following revised Privacy Act and PRA Statements into the form at its next scheduled reprinting Function - Child Age 6 to 12th Birthday Form SSA-3378-BK Privacy Act Statement Collection and Use of Personal...

How to fill out ssa 3378 bk 2003

How to fill out SSA-3378-BK?

1. Start by obtaining the form: The SSA-3378-BK form, also known as the Function Report-Adult, can be obtained from the Social Security Administration (SSA) website or by visiting your local SSA office. Make sure you have the most up-to-date version of the form.
2. Read the instructions: Before filling out the form, carefully read the instructions provided with the SSA-3378-BK. These instructions will guide you on how to complete each section accurately.
3. Provide personal information: Begin by providing your personal information, such as your name, Social Security number, date of birth, and contact information. Make sure all the information is correct and up to date.
4. Describe your daily activities: In this section, you will need to provide detailed information about your daily activities and how your impairments affect your ability to perform them. Give specific examples and be honest about any limitations you experience.
5. Discuss your ability to work and carry out tasks: This section requires you to describe your ability to work, including any difficulties you may face due to your impairments. Mention any jobs you can no longer perform and explain why.
6. Explain your medical conditions and treatments: Provide a comprehensive list of your medical conditions, including diagnoses, symptoms, and prescribed medications. If you are receiving any ongoing medical treatments or therapies, mention them as well.
7. Provide information about medical sources: Include the names and contact information of your healthcare providers, therapists, or any other medical professionals who have treated you for your impairments. This information will help SSA to gather the necessary medical evidence.
8. Describe your ability to handle social situations: This section asks about your ability to interact with others, including family, friends, and strangers. Mention any difficulties you encounter, such as anxiety, depression, or problems communicating effectively.
9. Sign and date the form: Once you have completed all the sections of the SSA-3378-BK form, make sure to sign and date it. Review your answers to ensure accuracy and completeness before submitting the form.

Who needs SSA-3378-BK?

1. Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may need to complete the SSA-3378-BK form. It is used to gather information about their functional limitations and the impact of their impairments on daily activities.
2. Individuals who have already applied for SSDI or SSI benefits but were asked to provide additional documentation or complete the Function Report-Adult may also need to fill out the SSA-3378-BK.
3. Any person who is applying for disability benefits and has impairments that affect their ability to work or perform daily activities should consult with the SSA or a qualified representative to determine if they need to complete the SSA-3378-BK.

Video instructions and help with filling out and completing ssa 3378 bk

Instructions and Help about ssa 3378 bk 2003

All right everybody greets this again is attorney Anthony Ruiz bringing you your social security legal beat tip and I got a couple of questions that have imposed out to me, I want to thank the individuals who are asking me about the workers comp offset as well as about the pain threshold what we call the pain standard as well as about the medically determinable impairment I'm going to address those and upcoming videos, but I wanted to address this one for Mr. CPU who asked me about the functional report forms third party glad you brought that up because that's something I like to talk to people about when this fullness part popped out when you file your disability application and your case gets transferred to the disability determination services one of the things they do is they will send out forms to you with your functional forms these functional forms are designed for you to describe what's going on in the course of your daily activities was coming in terms of what do you do when you get up in the morning how do you handle getting dressed when you do experience any problems don't you're cleaning the house or anything like that what most people don't also realize is that when they'll also ask you meaning in Social Security Administration is to provide them the name of at least two or three people who can provide them with information about your case or about you and what they do is they send them a form similar to the one that you receive this may sound wild, but I want you to keep in mind this somebody asked me once before why does Social Security send all these forms all over the place I don't understand I'll tell you one word consistency because a lot of times they want to see is what you're saying consistent with what everybody else is seeing as well let me give you a good example let's say for instance you say when you go to the grocery store that every time you go you got to ride in a motorized car, and you always have to go with someone you can never go by yourself, and then they send a form to your friend and your friend and ask them have you ever seen your friend go grocery shopping yeah I see him the other day when they were grocery shopping were there any problems' no they were walking around like we walked up and down the aisles together now see how that's a little different from you saying you're at a corporate cart, and you're the other friend of yours are saying they've seen you walking down the aisle that plays a part with your credibility because if you're not being consistent they're going to look at what you're saying in light of your condition with a little degree of suspect so the first thing they do is they look for consistency, and it's consistency throughout so when you get those functional reports they're trying to see are you embellishing them let me kind of add it a step further in some instances when you're apply in some states you have two appeals before you go before judge well the first appeal they're going to...

People Also Ask about ssa 3378 bk

Why did I receive a SSA-3380-BK?

Form SSA-3380-BK is filed with the Social Security Administration (SSA) to claim for social security benefits for a physically challenged person. This form is used when the applicant cannot fill out the form personally and requires the assistance of a third party.

How to fill out Social Security disability Questionnaire?

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.

What is the pain questionnaire for Social Security disability?

The pain questionnaire is asking how pain limits the individual and how often they are experiencing the pain. This form will also ask about any medications they are taking and any side effects the medication is causing. Side effects from medications can also help you show how else your client is limited.

Who fills out SSA-3380-BK?

The Form SSA 3380-BK is known as a Third Party Adult Function Report. This form will need to be filled out by a third party such as a friend or family member. It cannot be a medical professional. This person should be close to you, as this form asks very personal questions.

How do you answer a disability questionnaire?

How to Answer Disability Questionnaires Write clearly and legibly. Avoid erasures as much as possible. Do not leave any section of the form blank (unless otherwise specified). Give consistent answers. Answer the questions truthfully. Follow the instructions on the form.

When is pain considered a disability?

If you have a chronic pain condition that renders you incapable of working, you may qualify for Social Security disability (SSD) benefits. However, qualifying can be a challenge because the Social Security Administration has a strict definition of what it means to be disabled.

Do I have to fill out SSA 3380 BK?

Who needs Form SSA-3380-BK? The “Function Report – Adult – Third Party” form, also known as the SSA-3380-BK, is necessary for disabled citizens applying for social security and for their families while the applicant applies for, or appeals, their Social Security disability claim.

Who fills out form SSA-3380-BK?

Form SSA-3380-BK is a form used by an individual seeking disability benefits from the Social Security Administration. This is a function report for an adult that is completed by a third-party. The third-party chosen to complete this extensive form cannot be a medical professional treating the applicant.

How do you answer the question to qualify for disability?

How to Answer Disability Questionnaires Write clearly and legibly. Avoid erasures as much as possible. Do not leave any section of the form blank (unless otherwise specified). Give consistent answers. Answer the questions truthfully. Follow the instructions on the form.

For pdfFiller’s FAQs

What is ssa 3378 bk?

SSA-3378-BK is a Disability Report - Adult form used by the Social Security Administration to collect detailed information about an individual's medical conditions and how they affect their ability to work.

Who is required to file ssa 3378 bk?

Individuals who are applying for Social Security Disability benefits are required to file form SSA-3378-BK.

How to fill out ssa 3378 bk?

The SSA-3378-BK form can be filled out online on the Social Security Administration's website or completed during an in-person appointment with a Social Security representative.

What is the purpose of ssa 3378 bk?

The purpose of form SSA-3378-BK is to gather detailed information about an individual's medical conditions, treatment, and work history to help determine eligibility for Social Security Disability benefits.

What information must be reported on ssa 3378 bk?

The SSA-3378-BK form requests information about an individual's medical conditions, medical providers, medications, treatments, work history, and activities of daily living.

When is the deadline to file ssa 3378 bk in 2023?

The deadline to file form SSA-3378-BK in 2023 will vary depending on the individual's specific case and when they apply for Social Security Disability benefits. It is recommended to file the form as soon as possible after applying for benefits.

What is the penalty for the late filing of ssa 3378 bk?

The Social Security Administration may impose penalties for late filing of form SSA-3378-BK, which can include delays in processing the disability claim or potential loss of benefits. It is important to submit the form in a timely manner to avoid these penalties.

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