SSA-3373 (Formerly SSA-3373-BK) 2009 free printable template

FUNCTION REPORT ADULT — Form SSA-3373-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form, complete as much of it as you can and

How to fill out SSA-3373 Formerly SSA-3373-BK

How to fill out SSA-3373 (Formerly SSA-3373-BK)

1. Begin by downloading the SSA-3373 form from the Social Security Administration's website or obtaining a physical copy from a local office.
2. Fill in your personal information at the top of the form, including name, Social Security number, and contact information.
3. In section 1, describe your daily activities and how your condition affects them. Be specific about any limitations you face.
4. In section 2, list your medical conditions and the healthcare providers you have consulted. Include dates and any treatment you have received.
5. In section 3, detail any medications you are currently taking, including dosage and purpose.
6. In section 4, provide information about your work history, including the types of jobs you have held and the dates of employment.
7. Review your answers for accuracy and completeness before submitting the form.
8. Sign and date the form at the end, and keep a copy for your records.
9. Submit the completed form via mail or in-person at your local Social Security office.

Who needs SSA-3373 (Formerly SSA-3373-BK)?

1. Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.
2. People who have a medical condition that significantly impairs their ability to work.
3. Applicants who need to provide detailed information about their daily functioning and limitations due to their disability.

Who needs an SSA-3373-BK Form?

An SSA 3373-BK also called a Function Report, is required by disabled individuals when it is time to file a claim for disability benefits. This form is of extreme importance when applying for Social Security Disability.

What is SSA-3373-BK for?

The Form is designed to help the Social Security Administration analyze disability cases and make decisions about whether the SDI should be paid to persons who are unable to work. The questions of the form cover the following issues:

how the claimant’s physical condition limits his/her work

the claimant’s regular daily and specific activities

basic abilities

medication and side effects, etc.

Is the SSA-3373-BK accompanied by other forms?

To make a decision, the SSA usually requires the following information about the claimant and the case:

Social Security Number (provided by the claimant),

birth certificate (provided by the claimant),

medical information and diagnosis (confirmed by the medical institution the claimant addressed)

work information (provided by the employer).

When is the SSA-3373-BK due?

It is necessary to apply to the SDI in case the claimant’s impairment is expected to last for at least 12 months or to result in death.

How do I fill out SSA-3373-BK?

If there is a chance that the SSA won’t understand the handwriting due to its illegibility, it is advisable to ask a trusted person for help.

None of the questions must be left unanswered, and they all should provide relevant and detailed information.

Where do I send SSA-3373-BK?

The completed SSA Form 3373 must be submitted to the Social Security Administration for consideration.

People Also Ask about

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The SSA Form 89 verification report enables lenders to fully comply with the mortgage industry Social Security Number (SSN) verification requirements including the Fannie Mae Loan Quality Initiative.

What does an SSA 89 form do?

What Is Form SSA-89? Form SSA-89 is a Social Security form that authorizes the SSA to verify the connection between your name and your Social Security Number to a third party.

Why is my bank asking for SSA 89 form?

A lender may use an SSA 89 form in order to prevent identity fraud. Filling out this form is not a requirement to get a loan at all lenders. The government does not require lenders to complete this verification. The SSA 89 form must be completed by a person who wants to borrow money.

What is the purpose of the SSA-89 form?

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What was SSI 2009?

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What is form SSA L9790 SM?

Beneficiary completes Form SSA-L9790. The beneficiary completes the SSA-L9790 to provide the months he or she earned less than the monthly exempt amount, the number of hours he or she was engaged in self-employment, and whether he or she stopped working during the year(s) in question.

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What is SSA-3373 (Formerly SSA-3373-BK)?

SSA-3373 is a form used by the Social Security Administration to gather information regarding an individual's medical condition and functioning when applying for disability benefits. It is designed to collect evidence of the claimant's mental and physical capabilities.

Who is required to file SSA-3373 (Formerly SSA-3373-BK)?

Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may be required to file SSA-3373 to provide detailed information about their disabilities and how these conditions affect their daily lives.

How to fill out SSA-3373 (Formerly SSA-3373-BK)?

To fill out SSA-3373, applicants should carefully read the instructions provided with the form, complete all sections truthfully and accurately, and provide detailed responses regarding their medical conditions and limitations. It is important to include any supporting documentation from healthcare providers.

What is the purpose of SSA-3373 (Formerly SSA-3373-BK)?

The purpose of SSA-3373 is to collect detailed information about an applicant's impairments, limitations, and how these conditions affect their ability to work and perform daily activities. This information is critical for the Social Security Administration to make informed decisions regarding disability claims.

What information must be reported on SSA-3373 (Formerly SSA-3373-BK)?

The form requires information about the claimant's medical diagnosis, treatment history, limitations in daily activities, work history, and any other relevant details that describe how their condition impacts their ability to function.