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Form SSA3373 (102020) Discontinue Prior Editions Social Security Administration Page 3 of 10 OMB No. 09600681FUNCTION REPORT ADULT How your illnesses, injuries, or conditions limit your activities
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How to fill out function report ssa 3373

01
To fill out the Function Report SSA 3373, follow these steps:
02
Start by providing your name, social security number, and contact information.
03
Fill out your birth date, gender, and marital status.
04
Describe your illness, injury, or condition that affects your ability to work.
05
Explain how your condition limits your ability to perform various work-related activities such as standing, sitting, walking, lifting, etc.
06
Describe any assistive devices or accommodations you require to perform tasks.
07
Provide information about your education and work history.
08
List any previous jobs you have had in the past 15 years.
09
Describe the tasks you performed in those jobs and how your condition affected your ability to do them.
10
Indicate if you require assistance or supervision to perform daily activities.
11
Explain any changes in your condition or treatment.
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Lastly, review the completed form and make sure all the information is accurate before submitting it.

Who needs function report ssa 3373?

01
Function Report SSA 3373 is needed by individuals who are applying for or receiving Social Security Disability benefits. It is required to provide detailed information about the individual's ability to perform work-related activities due to their illness, injury, or condition. This report helps the Social Security Administration assess the individual's eligibility for disability benefits based on their functional limitations.
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The Function Report SSA-3373 is a form used by the Social Security Administration to gather information about how a person's disability affects their daily functioning.
Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may be required to file a Function Report SSA-3373.
To fill out the Function Report SSA-3373, one should provide detailed information regarding their daily activities, how their condition limits their ability to perform these activities, and any help they require from others.
The purpose of the Function Report SSA-3373 is to assess the impact of the claimant's disability on their ability to function in daily life and to aid in the evaluation of their disability claim.
The Function Report SSA-3373 requires information about the claimant's daily activities, social interactions, ability to handle tasks, and other relevant details concerning how their disability affects their life.
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