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SSA-3380-BK 2004 free printable template

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FUNCTION REPORT ADULT — THIRD PARTY Form SSA-3380-BK. READ ALL or THIS INFORMATION BEFORE A. YOU BEGIN COMPLETING THIS FORM ...
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How to fill out SSA-3380-BK

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How to fill out SSA-3380-BK

01
Start by downloading the SSA-3380-BK form from the Social Security Administration's website.
02
Read the instructions carefully before filling out the form.
03
Provide your personal information including your full name, address, and Social Security number in the designated sections.
04
Answer the questions regarding your medical history and current health condition accurately and to the best of your ability.
05
If applicable, include information about medications you are currently taking.
06
Detail your daily activities and how your condition affects your ability to perform them.
07
Review your answers to ensure all information is correct and complete.
08
Sign and date the form where indicated, certifying that the information provided is true.
09
Submit the completed form either online, by mail, or in person at your local Social Security office.

Who needs SSA-3380-BK?

01
Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) who have mental impairments.
02
Beneficiaries undergoing a continuing disability review by the Social Security Administration.
03
Individuals seeking to provide updated information about their mental health condition.

Who needs an 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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People Also Ask about

Third Party Adult Function Report is a form that Social Security sometimes send to your contact person. This form is usually sent out two or three months after you first apply. It is also sometimes used during Continuing Disability Reviews, for people who are already on disability.
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.
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 you can. When a question refers to the "disabled person," it refers to the person who is applying for or receiving disability benefits.
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.
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.

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SSA-3380-BK is a form used by the Social Security Administration (SSA) to collect information about an individual's mental or physical impairment that affects their ability to work.
Individuals who are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits due to a disability may be required to file SSA-3380-BK.
To fill out SSA-3380-BK, you should carefully read the instructions provided with the form, provide accurate and complete information regarding your conditions, treatments, and how your impairments limit your daily activities.
The purpose of SSA-3380-BK is to gather detailed information about a person's disability to help the SSA determine eligibility for disability benefits.
The form requires information about the nature of the disability, medical treatment, daily activities, and the impact of the impairment on social and functional abilities.
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