SSA-3379-BK 1995 free printable template

Form SSA-3379-BK 5-95 Continued on the Rever se v Printed on recycled paper The Pr ivacy And Paper wor k Reduction Acts The Social Security Administration is authorized to collect and 1631 e 1 of the Social Security Act. H. Does the child s impairment s affect his or her social activities or behavior with other people Has friends his or her own age Can make new friends Generally gets along with you or other adults brothers or sisters Plays team sports for example baseball basketball soccer...

How to fill out SSA-3379-BK

How to fill out SSA-3379-BK

1. Start by downloading the SSA-3379-BK form from the Social Security Administration website.
2. Read the instructions carefully before filling out the form.
3. Fill in your personal information, including your name, Social Security number, and contact details.
4. Provide details about your medical condition, including diagnoses and any relevant treatment history.
5. Answer the questions about your daily activities and limitations due to your condition.
6. Include information about any medications you are taking.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form before submission.

Who needs SSA-3379-BK?

1. Individuals who are applying for Social Security disability benefits and need to provide information about their mental impairments or limitations.

Instructions and Help about SSA-3379-BK

Heather this is Jonathan Ginsberg I'd like to talk to you today about Social Security disability claims based on a condition known as schizophrenia now schizophrenia is a very, very serious mental illness, and generally it means that a person has lost touch with reality for a significant portion of the day or week or whatever it may be it doesn't mean that that person is always out of touch with reality but for a significant amount of time and certainly enough time that would prevent competitive work this person is lost touch with reality and sometimes that can mean anything from hearing things or seeing things or perceiving the world in a very odd way that can be grounds for finding a person disabled and there's a couple different ways to win on schizophrenia one obviously is to meet the listing I believe it's a 12-point oh three where you have to document that you not only have this diagnosis but your ability to function and things like activities of daily living have been severely compromised the second way to win a schizophrenia case is even if you don't meet the listing to argue your functional capacity for work has been so reduced by the symptoms you're experiencing that you would not be reliable even a simple entry-level job, and literally I'm talking about a simple one or two-step job being a ticket taker to a movie theater assembling small parts surveillance system monitor as a cashier something like that where basically you're not having not being in touch with reality to the point where you would not be able to focus and concentrate and get through a workday eight hours a day five days a week now the thing I find in cases involving schizophrenia is normally my clients are under the care of a psychiatrist they're receiving medications and again sometimes the medications can control the symptoms sometimes they can and so what judges are typically looking for situations where a person has been under treatment from a psychiatrist that he is he or she has tried different medications that the medications either work for only a short period of time then they lose their effectiveness or the person the doctor has been trying different medications over six eight ten months without success in controlling the symptoms and generally when I go to hearing again I'm looking for a medical record that shows that the doctor has not been successful over six months say typically about six months at least of controlling the symptoms that the doctors medical records indicate that there's been a real problem keeping these symptoms under control and a very descriptive annotation about the various symptoms so that we know what's going on what the problems are and again a lot of times it's seeing things or not they're hearing voices perceiving that somebody's following you think like that now also what I do in terms of evidence is normal in cases involving schizophrenia because my client a lot of times is not perceiving all the issues going on a lot of times...

People Also Ask about

What is the SSA authorization form?

Form SSA- 827 (.pdf) SSA and its affiliated State disability determination services use Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" to obtain medical and other information needed to determine whether or not a claimant is disabled.

What is the SSA form for work history?

The Work History Report (SSA-3369) helps Disability Determination Services (DDS) to obtain detailed vocational information about the jobs the applicant held in the 15 years prior to becoming unable to work due to his or her illnesses, injuries, or conditions.

Can you print a Social Security application online?

Today, you can apply for retirement, disability, and Medicare benefits online, check the status of an application or appeal, request a replacement Social Security card (in most areas), print a benefit verification letter, and more – from anywhere and from any of your devices!

How do you answer a disability function report?

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.

Does SSA show work history?

From your first job to your last, your employer verifies your Social Security number with us to help reduce fraud and allow us to keep track of your work history to ensure you get the benefits you deserve.

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What is SSA-3379-BK?

SSA-3379-BK is a form used by the Social Security Administration (SSA) to gather information about an individual's ability to work, specifically focusing on issues related to mental impairments.

Who is required to file SSA-3379-BK?

SSA-3379-BK is typically filed by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) who have mental health conditions impacting their ability to work.

How to fill out SSA-3379-BK?

To fill out SSA-3379-BK, individuals should carefully read the instructions provided with the form, providing clear and accurate information regarding their mental condition, limitations, and related health care details.

What is the purpose of SSA-3379-BK?

The purpose of SSA-3379-BK is to evaluate an applicant's mental impairments and their impact on their capacity to engage in substantial gainful activity, aiding the SSA in making informed decisions regarding disability claims.

What information must be reported on SSA-3379-BK?

Information reported on SSA-3379-BK includes details about mental health conditions, treatment history, daily activities, social interactions, and any limitations in work-related functions due to these conditions.