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Adult Form (Please Print) Date___/___/___Social Security #_________Name ___Gender:Address ___***Referred by ___City ___State ___Zip ___Spouse Name ___Home phone ( ___) ___ ___Spouse Social Security
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01
Gather all necessary personal information and documentation.
02
Complete the personal information section of the form with accurate and up-to-date information.
03
Provide detailed information about your medical conditions and how they impact your ability to work.
04
Include information about medical treatments and medications you are currently receiving.
05
Sign and date the form before submitting it to the Social Security Administration.

Who needs adultform ssa-3373-bk - function?

01
Individuals who are applying for Social Security disability benefits.
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The adult form SSA-3373-BK is a questionnaire used by the Social Security Administration to gather information about an individual's functioning and daily activities as part of the disability determination process.
Individuals who are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may be required to file the adult form SSA-3373-BK as part of their application.
To fill out the adult form SSA-3373-BK, individuals should provide detailed responses to the questions regarding their daily activities, limitations, and how their impairments affect their ability to function in various areas of life.
The purpose of the adult form SSA-3373-BK is to assess an applicant's functional capabilities and limitations, which are crucial for determining eligibility for disability benefits.
The information that must be reported on the adult form SSA-3373-BK includes personal details, medical conditions, daily living activities, social interactions, and how impairments affect the individual's ability to work.
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