SSA-3373 (Formerly SSA-3373-BK) 2013 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. Start by downloading the SSA-3373 form from the Social Security Administration's website.
2. Fill out the applicant's personal information at the top, including name, Social Security number, and contact details.
3. Provide details about the medical condition or disability being claimed, including dates of diagnosis and treatment.
4. Describe how the condition affects daily activities, work ability, and overall functioning.
5. Include information on past employment and how the disability affects work-related tasks.
6. List the names and contact information of medical professionals who have treated the applicant.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form before submission.

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

1. Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
2. Those who have a medical condition that significantly impairs their ability to work.
3. Claimants who need to provide detailed information about their condition for a disability evaluation.

• Who needs an SSA-3373-BK Form?
• What is an SSA-3373-BK Form Used for?
• Is an SSA-3373-BK Form Accompanied by Other Forms?
• • What Information Should be Provided in an SSA-3373-BK Form?
  • How do I fill out an SSA-3373-BK Form?
  • Where do I send an SSA-3373-BK Form?

Who needs an SSA-3373-BK Form?

People who want to report their illnesses, conditions or injuries limiting their lives should use this form.

What is an SSA-3373-BK Form Used for?

This form is an essential paper while applying for any kind of benefits from the employer or government. While asking for some aid you will automatically explain how your life is limited and how the requested benefit can help you.

Is an SSA-3373-BK Form Accompanied by Other Forms?

An SSA-3373-BK Form is not accompanied by other forms. It doesn't need any attachments as well. If you lack some space while answering some questions you can use a “REMARKS” section on the leis page of the form.

What Information Should be Provided in an SSA-3373-BK Form?

• Disabled person's name

• Social Security Number

• Phone number

• Habitation information

• How do reported circumstances limit your ability to work

• Information about daily activities

• Information about abilities

• Medicines taken

• Etc

How do I fill out an SSA-3373-BK Form?

You shouldn't leave fields blank. If you are not sure about the answer you should either call a Social Security and ask them for help or simply write “Don't know”. This form doesn't require any special knowledge. This is made for you to fill it out on your own. If either the explanation is asked for or you need to explain the answer, be sure to explain the answer. If you need some more space to answer any question, there's “REMARKS” section on the last page for it. Don't forget to write the number of question being answered while using the “REMARKS” section.
Don't write on the “For SSA Use Only” section.

Where do I send an SSA-3373-BK Form?

It is sent to the establishment which made a request for it.

People Also Ask about

What is the question 6 on the function report?

Question 6: Describe what you do from the time you wake up until going to bed. When I ask many of my clients this question, they'll often answer, “not much.” However, you are always doing something. When you file a disability claim, you need to provide specific details.

What do I write on SSA 3373 form?

The first section of SSA-3373 asks for basic contact information and about your living situation.Questions 1-3: Contact information Your name. Social Security number. Daytime telephone number where someone can call you or at least leave a message for you if they have questions.

How do you answer the function report for Social Security?

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.

How do you fill out a daily living activity?

Tips for Completing the Activities of Daily Living Questionnaire Be honest. You do not want to exaggerate or understate your limitations and abilities. Give as many details as you can so that the person reading the questionnaire gets an accurate idea of what your life is like on a daily basis.

How do I fill out a SSA function report?

How to Fill Out an Adult Function Report for Disability (7 Tips) Answer Every Question and Be Honest! Answer Only the Questions Being Asked. Give as Much Detail as You Can. Be Consistent (Some Questions Overlap) Be Specific on Question 5 of the Function Report. Don't Limit Your Answers to the Space on the Form.

How do you answer question 6 on a function report?

Question 6: Describe what you do from the time you wake up until going to bed. When I ask many of my clients this question, they'll often answer, “not much.” However, you are always doing something. When you file a disability claim, you need to provide specific details.

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

SSA-3373 is a form used by the Social Security Administration to collect information about an individual's daily functioning and limitations due to their mental and physical impairments.

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

Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) may be required to file SSA-3373 as part of their application process.

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

To fill out SSA-3373, complete the form by providing detailed information about your daily activities, social interactions, work history, and the impact of your impairments on your ability to function.

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

The purpose of SSA-3373 is to gather comprehensive information about an individual's limitations and the effects of their condition on their daily life, which helps in determining eligibility for disability benefits.

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

The form requires reporting information on daily activities, social functioning, concentration, persistence, pace, and any changes in behavior or mood as a result of impairments.