Get the free Function Report Adult 3373 - Social Security Law Center
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FM CIO REPORT ADULT — Form SSA-3373-BK READ ALL OF THIS I FORMATION BEFORE YOU BEGIN COMPLETE G THIS FORM IF YOU EED HELP If you need help with this form, complete as much of it as you can and call
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How to fill out function report adult 3373
How to fill out function report adult 3373:
01
Download or obtain a copy of the function report adult 3373 form.
02
Begin by providing your personal information at the top of the form, including your name, address, and contact details.
03
Indicate your Social Security number in the designated field.
04
Specify the type of benefits you are currently receiving, such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
05
Answer the questions in the form regarding your medical condition and any changes you have experienced since your last report.
06
Provide detailed information about your daily activities, including your ability to perform tasks such as cooking, cleaning, shopping, and personal care.
07
Describe any difficulties or limitations you face in carrying out these activities due to your medical condition.
08
Include information about any assistive devices or accommodations you require to perform daily tasks.
09
If applicable, provide details about the therapy or treatment you are receiving and explain how it impacts your ability to function.
10
If you have been employed or engaged in work-like activities, disclose the nature of your work and any adjustments made to accommodate your condition.
11
Sign and date the form, and ensure that all required sections are completed before submitting it.
Who needs function report adult 3373:
01
Individuals who are currently receiving Social Security disability benefits such as SSDI or SSI.
02
Those who have experienced changes in their medical condition or functional abilities since their last report.
03
Individuals who need to update the Social Security Administration about their ability to work and perform daily activities.
Note: It is important to consult the official instructions provided by the Social Security Administration or seek assistance from a professional when filling out the function report adult 3373 form to ensure accuracy and completeness.
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What is function report adult 3373?
Function report adult 3373 is a form used to assess an adult's ability to function in daily activities.
Who is required to file function report adult 3373?
Healthcare professionals, caregivers, or family members may be required to file function report adult 3373.
How to fill out function report adult 3373?
Function report adult 3373 should be filled out by providing accurate and detailed information about the adult's daily functioning abilities.
What is the purpose of function report adult 3373?
The purpose of function report adult 3373 is to evaluate the adult's ability to independently perform daily tasks and make informed decisions.
What information must be reported on function report adult 3373?
Information such as the adult's mobility, self-care, communication skills, and cognitive abilities must be reported on function report adult 3373.
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