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SSA-3373 (Formerly SSA-3373-BK) 2013 free printable template

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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
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SSA-3373 (Formerly SSA-3373-BK) Form Versions

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How to fill out ssa 3373 function report

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How to fill out SSA 3373 Function Report:

01
Start by carefully reviewing the instructions provided with the SSA 3373 Function Report form.
02
Begin by providing your personal information, such as your name, social security number, and contact details.
03
Next, you will need to describe your medical condition and impairments. Be as thorough and specific as possible, including details about any treatments, medications, or therapies you are undergoing.
04
The form will also require you to explain how your condition affects your daily activities. Provide examples of any limitations or difficulties you experience in tasks such as walking, lifting, or concentrating.
05
You will also need to describe your ability to perform activities such as cooking, cleaning, shopping, driving, and taking care of personal hygiene. Include any modifications or assistance you require to carry out these activities.
06
The form may inquire about your ability to interact with others and participate in social activities. Be honest about any challenges you face in communicating, socializing, or maintaining relationships.
07
Additionally, the form may ask about your work history and any attempts you have made to work despite your condition. Provide details about the types of jobs you have held and if you were able to perform your duties adequately.
08
Finally, carefully review your completed SSA 3373 Function Report form for accuracy and completeness before submitting it.

Who needs SSA 3373 Function Report:

01
Individuals who are applying for or receiving Social Security disability benefits may be required to complete the SSA 3373 Function Report.
02
Those who have a medical condition or impairment that significantly affects their ability to work or perform daily activities are likely to need the SSA 3373 Function Report.
03
The report is also necessary for individuals who are seeking a reevaluation of their disability status or an adjustment to their benefits.

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.

Instructions and Help about ssa 3373 function report

2015 annual state of corruption report the cost of corruption on the economy politics and service delivery in Zimbabwe 2002 2015 corruption in Zimbabwe is a topical developmental economic and governance policy issue it is directly related to key challenges that Zimbabwe continues to face these challenges include unemployment poverty capital flight deindustrialization low investment rates poor social service delivery political anger violence and civic protest this presentation introduces you to the findings of the 2015 annual state of corruption report by Transparency International Zimbabwe the report entitled political economy of corruption and the battle for accountability in Zimbabwe explored the cumulative cost of corruption on three key governance sectors economics politics social service delivery from the year 2000 to 2015 the Shone a Dodge woodsy another era para SU girl meaning a goat grazes from where it is tied has become everyday language corruption in Zimbabwe has reached endemic levels Zimbabwe continues to score badly on the corruption perception index and in comparison to its neighbors such as Botswana in 2014 the national corruption barometer x TI Zed and the 2015 Afro barometer corroborated that corruption is on the increase in Zimbabwe a majority of citizens in the range of 68 to 70 four percent in Zimbabwe believe that corruption is on the increase with bribery being the common form of corruption that citizens experience and relate to within their day-to-day lives when interacting with public institutions Zimbabwe also performs well below the regional average on the 2015 Heritage Foundation index of economic freedom especially in terms of freedom from corruption ranking at 21 out of 100 and is placed at the bottom of the regional rankings the country also performs extremely poorly in all six governance areas assessed by the 2013 World Bank worldwide governance indicators scoring 2.87 on a 0-200 scale in terms of freedom from corruption 2.37 in terms of rule of law 2.39 in terms of regulatory quality 12.9 to in terms of government effectiveness 9.95 in terms of voice and accountability and finally 24 point 17 in terms of political stability and absence of violence the most prevalent forms of corruption in Zimbabwe are at the grand and petty levels grand corruption typically takes place at the top levels of the public sphere and the senior management levels in business where policies and rules are formulated and executive decisions are made it also often involves large sums of money the majority of perpetrators of grand corruption in Zimbabwe are political actors with political backing and influence grand corruption is best understood from the context of factional and predatory politics due to factional fighting in Zimbabwe's ruling party Zanuck a series of scandals have been exposed by political players to discredit one another these scandals and allegations have only surfaced as a result of political infighting in most of the...

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The SSA-3373 Function Report is a form used by the Social Security Administration (SSA) to collect information about an individual's ability to perform daily activities and tasks. It is typically used during the evaluation process for disability benefits claims. The form asks detailed questions about an individual's physical and mental capabilities, including their ability to stand, walk, sit, lift, concentrate, remember, and interact with others. The information provided in the report helps the SSA assess the individual's functional limitations and determine their eligibility for disability benefits.
The SSA-3373 Function Report is typically completed by individuals who are applying for Social Security Disability benefits or updating their disability status with the Social Security Administration. This report helps the SSA assess an individual's daily activities, abilities, and limitations to determine their eligibility for disability benefits.
To fill out the SSA 3373 function report, follow these steps: 1. Start with your personal information: - Provide your full name, Social Security Number, and contact information. - Include the name and contact information of a person who knows about your condition and can provide additional information if needed. 2. Section 1: Describe your daily activities: - Explain what activities you can and cannot do due to your physical or mental condition. - Mention if you need assistance in performing any tasks. 3. Section 2: Ability to complete tasks: - Check the boxes that best describe your capability to perform certain tasks. - Provide details on your limitations and difficulties in doing specific activities. 4. Section 3: Physical abilities and limitations: - Explain how your physical condition affects your ability to perform tasks such as standing, walking, bending, lifting, handling objects, etc. - Provide details about any assistive devices you require. 5. Section 4: Mental abilities and limitations: - Describe how your mental condition affects your ability to concentrate, understand, remember, follow instructions, and interact with others. - Mention any difficulty you face in handling stress, changes in routine, or conflicting instructions. 6. Section 5: Medications and side effects: - List all the medications, dosages, and frequency you take. - Describe any side effects or limitations caused by medications. 7. Section 6: Medical treatments: - Mention any ongoing medical treatment, therapy, or consultations you receive. - List the names and contact information of your medical providers. 8. Section 7: Other impairments or limitations: - Describe any additional impairments or limitations that impact your daily activities. 9. Section 8: Information from others: - Include statements or reports from individuals who are aware of your condition, such as doctors, therapists, employers, or family members. 10. Section 9: Remarks: - Use this section to provide any additional information not covered in earlier sections. 11. Sign and date the form: - Review all the information provided and sign the form along with the date. - Enclose any supporting documents or medical records, if available. Remember to be honest and thorough while filling out the form. Use additional attachment sheets if necessary to provide more details about your condition and limitations.
The SSA 3373 Function Report, also known as the Adult Function Report, is a form used by the Social Security Administration (SSA) to assess an individual's ability to perform daily activities and work-related tasks. The purpose of this report is to gather information about an individual's physical and mental functioning, limitations, and their ability to carry out activities of daily living (such as personal care, household chores, and social interactions). The information provided on this form is used by the SSA in the evaluation process for disability claims, specifically for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits. The details provided in the report help determine if the individual qualifies for disability benefits based on their impairments and limitations, and how these limitations affect their ability to work and function in daily life.
The SSA 3373 Function Report is a form used by the Social Security Administration to gather information about an individual's daily activities and ability to function in various areas. The information reported on this form includes: 1. Personal information: Name, address, SSN, contact information. 2. Medical conditions: A list of all physical and mental impairments or illnesses that affect the individual's ability to function. 3. Daily activities: A description of the individual's typical daily routine, including activities such as personal care, household chores, cooking, shopping, and recreation. 4. Ability to work: Information about the individual's ability to perform work-related tasks, including physical activities, lifting, standing, sitting, and any limitations or difficulties experienced. 5. Social functioning: Information about the individual's ability to interact with others, maintain relationships, and participate in social activities. 6. Concentration and memory: A description of any difficulties in focusing, paying attention, remembering, or following instructions. 7. Medications and treatments: Details about the medications, treatments, and therapies the individual is receiving for their conditions. 8. Assistance received: Information about any help or support the individual receives from others in performing daily activities or managing their conditions. 9. Changes in abilities: Any changes in the individual's abilities over time, including improvements or worsening of their conditions. 10. Other relevant information: Any other information that the individual feels is important to share regarding their daily activities and functioning. It is important to provide honest and detailed information on the SSA 3373 Function Report to help the Social Security Administration assess the individual's eligibility for disability benefits.
The Social Security Administration (SSA) does not explicitly state a penalty for the late filing of the SSA-3373 Function Report. However, it is generally advisable to file the form as soon as possible to prevent any delays in processing your application or potentially having your benefits denied or delayed. It is important to comply with SSA guidelines and deadlines to ensure a smooth application process.
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