SSA-3033 2016 free printable template

Social Security Administration Retirement, Survivors and Disability Insurance Supplemental Security Incomplete: Claim Number: Social Security Number: Worker's Name:Dear Sir or Madam: We are writing

How to fill out ssa 3033 2016 form

How to fill out SSA 3033:

1. Obtain the SSA 3033 form from the Social Security Administration website or local SSA office.
2. Provide your personal information, including your name, social security number, and contact details.
3. Indicate whether you are the claimant or representative payee by checking the appropriate box.
4. If you are the claimant, provide information about your disability, such as the type of disability and the date it began.
5. Fill in the details of any medical treatment you have received for your disability, including the healthcare provider's name and contact information.
6. Provide a list of medications you are currently taking for your disability.
7. If you have previously applied for Social Security benefits, indicate the type of benefits and the date of your last application.
8. If you are a representative payee, provide information about the claimant's disability and medical treatment.
9. Review your completed form for accuracy and sign and date it.
10. Submit the SSA 3033 form to the Social Security Administration either online or by mail.

Who needs SSA 3033:

1. Individuals who are applying for Social Security disability benefits and are unable to manage their own finances may need to fill out the SSA 3033 form.
2. Representative payees who are responsible for managing the finances of individuals receiving Social Security disability benefits may also be required to complete the SSA 3033 form.
3. The SSA 3033 form helps the Social Security Administration assess the claimant's ability to handle their own finances and determine whether a representative payee is necessary.

Video instructions and help with filling out and completing ssa 3033 fillable

Instructions and Help about 3033 form

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...

For pdfFiller’s FAQs

What is ssa 3033?

SSA 3033 is a form used by the Social Security Administration (SSA) in the United States. This form is a Disability Report Adult - Third Party Function Report, which is filled out by a third party (such as a friend, family member, or caregiver) to provide information about an adult applicant's daily activities, abilities, and limitations. The purpose of SSA 3033 is to assist the SSA in evaluating the applicant's claim for disability benefits.

Who is required to file ssa 3033?

The SSA 3033 form is used by an individual or their representative to request an appointment to review their official Social Security Administration (SSA) file in person. This is typically utilized for purposes such as correcting information or resolving issues related to Social Security benefits. Hence, the individual or their representative is required to file the SSA 3033 form.

How to fill out ssa 3033?

To fill out SSA-3033, also known as the Function Report-Adult, follow these steps: 1. Provide personal information: Fill in your name, social security number, and contact information. 2. Background information: Mention the date you became unable to work due to your disability, the names and addresses of your doctors, and the dates of your hospitalizations, if any. 3. Description of your disability: Write a brief description of your disability and how it affects your ability to work, perform daily activities, and engage in social interactions. 4. Daily activities: List all the activities you do in a typical day, such as cooking, cleaning, bathing, dressing, shopping, etc. Indicate if you need assistance with any of these activities. 5. Ability to concentrate and complete tasks: Explain if you have difficulty staying focused, following instructions, and completing tasks due to your disability. 6. Physical limitations: Describe any physical limitations you have, such as difficulty standing, sitting, walking, lifting, or using your hands. 7. Changes in your abilities: Outline any changes in your abilities since your disability began, such as worsening pain or decreased mobility. 8. Medications and treatments: List all the medications and treatments you are taking or undergoing for your disability. Include any side effects or limitations caused by these medications. 9. Assistance from others: Specify if you need help from others to manage your daily activities or take care of yourself. 10. Social functioning: Write about any difficulties you experience in social situations, such as interacting with others, maintaining friendships, or joining social activities. 11. Emotional challenges: Discuss any emotional challenges you face due to your disability, such as depression, anxiety, or mood swings. 12. Additional information: You can provide any additional relevant information or details about your disability and its impact on your life. 13. Authorization and signature: Sign the form and include the date. 14. Review the completed form for any errors or missing information before submitting it to the Social Security Administration (SSA). Note: It is advisable to consult with an attorney or representative familiar with SSA forms and processes to ensure the accuracy and completeness of your submission.

What is the purpose of ssa 3033?

The SSA 3033 form is used by the Social Security Administration (SSA) to collect information on an individual's work history and employment status. The purpose of the SSA 3033 is to gather details about an individual's past and current employment, including job titles, duties, dates of employment, and earnings. This form is typically required when an individual applies for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. It helps the SSA assess an individual's eligibility for these benefits by determining their work credits, which are based on the amount of income earned and the duration of employment. By gathering information through the SSA 3033, the SSA can accurately evaluate an individual's work history and determine if they meet the necessary criteria for receiving SSDI or SSI benefits.

What information must be reported on ssa 3033?

The SSA 3033, also known as the Function Report-A-Adult, is a form used by the Social Security Administration to gather information about an individual's ability to perform daily activities, in order to evaluate their eligibility for disability benefits. The information that must be reported on the SSA 3033 includes: 1. Personal identification information: Name, Social Security number, contact information, and the names and relationships of household members. 2. Medical conditions: Detailed information about any physical or mental health conditions that affect the individual's ability to work, including diagnoses, treatments, medications, symptoms, and side effects. 3. Work history: A detailed work history, including information about past jobs, job tasks, work schedule, and reasons for leaving or losing jobs due to a medical condition. 4. Daily activities: Description of the individual's ability to perform various daily activities independently, such as personal care, housework, shopping, cooking, and managing finances. 5. Limitations and difficulties: Specific limitations and difficulties faced by the individual in performing daily activities or social interactions, due to their medical condition. 6. Assistance and support: Information about any help received from others, such as family members, friends, or assistive devices, in performing daily activities. 7. Ability to concentrate: Information about the individual's ability to concentrate, follow instructions, complete tasks, and handle stress and changes in routine. 8. Participating in hobbies or interests: Information about the individual's ability to engage in hobbies or interests, such as reading, watching television, socializing, or participating in sports or recreational activities. 9. Travel: Information about the individual's ability to travel independently and any difficulties faced during transportation. 10. Other relevant information: Any other information that may be relevant to the individual's ability to work, such as pain levels, side effects of medication, or changes in medical conditions over time. It's important to provide accurate and detailed information on the SSA 3033 form, as it plays a crucial role in determining disability benefits eligibility. It is recommended to include specific examples and details to support the reported limitations and difficulties.

What is the penalty for the late filing of ssa 3033?

The penalty for the late filing of SSA-3033, also known as the Representative Payee Report, can vary depending on the circumstances and the discretion of the Social Security Administration (SSA). Generally, failure to file the report on time may result in a warning or a request for the report to be filed immediately. However, if the representative payee consistently fails to file the report or knowingly provides false information, the SSA may take further action, which could include fines, termination of the payee's appointment, or legal consequences. It is important to consult the SSA directly for specific information and guidance in your situation.

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