SSA-3378-BK 2017-2026 free printable template

Form SSA-3378-BK 10-2017 UF Discontinue Prior Editions Social Security Administration Page 1 of 12 OMB No. 0960-0542 Function Report - Child Age 6 to 12th Birthday Filling Out The Function Report IF YOU NEED HELP COMPLETING ANY PART OF THIS FORM CONTACT YOUR SOCIAL SECURITY OFFICE. WE WILL HELP YOU. The information that you give us on this form will be used by the office that makes the disability decision on the child s claim* You can help them by completing as much of the form as you can*...

How to fill out ssa 3378 bk child form

How to fill out SSA-3378-BK

1. Obtain the SSA-3378-BK form from the Social Security Administration website or local office.
2. Begin by filling in your personal information at the top of the form, including your name, Social Security number, and contact details.
3. Provide details about your medical conditions and any impairments that may affect your ability to work.
4. Complete the sections regarding your daily activities and how your condition limits these activities.
5. Fill out any relevant information about your past work history and how your impairments impact your job performance.
6. Review the form for accuracy and completeness before signing and dating it at the bottom.
7. Submit the completed form to the appropriate Social Security office, either by mail or in person.

Who needs SSA-3378-BK?

1. Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) who have disabilities affecting their ability to work may need to fill out the SSA-3378-BK form.

People Also Ask about omb no 0960 0499

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.

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.

What is the SSA activity of daily living questionnaire?

The Activities of Daily Living Questionnaire is more formally known as Function Report – Adult – Form SSA-3373-BK. This form asks about your abilities and limitations in performing tasks such as caring for yourself and your household.

How long can you pay attention to SSA 3373?

You only have a limited time to comply (10 days from the date of the letter) with Social Security's request so don't delay. But, don't rush through your answers either. Your Adult Function Report, also known as SSA 3373, stays on the record through your entire case and cannot be modified.

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.

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.

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What is SSA-3378-BK?

SSA-3378-BK is a form used by the Social Security Administration (SSA) to gather information about a claimant's ability to work and any disabilities they may have.

Who is required to file SSA-3378-BK?

SSA-3378-BK is typically required to be filed by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.

How to fill out SSA-3378-BK?

To fill out SSA-3378-BK, applicants should provide detailed information about their medical conditions, daily activities, education, work history, and how their impairments affect their ability to function.

What is the purpose of SSA-3378-BK?

The purpose of SSA-3378-BK is to collect necessary information that helps the SSA evaluate a claimant's disability status and determine eligibility for benefits.

What information must be reported on SSA-3378-BK?

SSA-3378-BK requires information about the applicant's medical conditions, treatments, daily limitations, work history, and any assistance needed in performing daily activities.