Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
SSA-3373 is a form used by the Social Security Administration (SSA) in the United States. The form is called the Function Report-Adult, and it is used to gather information about an individual's daily activities, abilities, and limitations in order to evaluate their eligibility for disability benefits from the SSA. The form asks questions about the individual's ability to perform various daily activities, their ability to work, their medical conditions, and any limitations or restrictions they may have.
Who is required to file ssa 3373?
SSA-3373 is a form used by the Social Security Administration (SSA). It is the "Function Report - Adult - Third Party" form. This form is typically completed by a third-party individual, such as a family member, friend, or caregiver, who has personal knowledge of an individual's daily activities and ability to function. The individual filling the form is required to file it if they are acting as a third-party representative for someone applying for or receiving Social Security Disability benefits.
How to fill out ssa 3373?
To fill out SSA-3373, the Function Report - Adult - Third Party, follow these steps:
1. Start by downloading the SSA-3373 form from the official Social Security Administration (SSA) website or visit your local SSA office to obtain a physical copy.
2. Begin answering the form by providing the claimant's personal information at the top of the page. This includes their name, Social Security number, and contact information.
3. Section 1: Nature of the Relationship - Specify the nature of your relationship with the claimant, such as a family member, friend, healthcare professional, or any other relevant affiliation.
4. Section 2: How and when your child's illnesses, injuries, or conditions limit their ability to work or function - Describe the specific and substantial limitations of the claimant's physical and mental abilities. Provide examples of daily activities they struggle with, such as bathing, getting dressed, cooking, cleaning, shopping, or interacting with others.
5. Section 3: Your observations about how your child's illnesses, injuries, or conditions limit his/her ability to function - Elaborate on any specific changes you have noticed in the claimant's behavior, routines, or demeanor. Describe any difficulties they face in concentration, memory, understanding, following instructions, or completing tasks.
6. Section 4: Your observations about how your child's illnesses, injuries, or conditions limit his/her ability to complete tasks - Provide examples of how the claimant's illnesses, injuries, or conditions impact their ability to carry out specific tasks such as household chores, driving, shopping, engaging in recreational activities, or attending appointments.
7. Section 5: Your observations about your child's behavior, interactions, and limitations - Detail any changes you have observed in the claimant's behavior, mood, personality, or social interactions due to their illnesses, injuries, or conditions.
8. Section 6: Additional information - Include any additional relevant information that could assist the SSA in evaluating the claimant's disability claim. This could include doctors' statements, medical records, or other supporting documentation.
9. Sign and date the form after completing all the necessary sections.
10. Attach any supporting documentation mentioned in Section 6.
11. Submit the completed SSA-3373 form either by mail to your local SSA office or directly through the SSA's online portal, if available in your region.
It's important to provide accurate and detailed information while filling out the form. If you have any questions or are uncertain about any sections, consider seeking assistance from an attorney or contacting the SSA directly for guidance.
What is the purpose of ssa 3373?
The purpose of SSA 3373 (Function Report – Adult) is to collect detailed information about an individual's daily activities, ability to perform tasks, and limitations due to their medical condition or disability. This form is used by the Social Security Administration (SSA) as part of the evaluation process when determining an individual's eligibility for Social Security Disability benefits. The information provided on this form helps the SSA assess the individual's functional limitations and their ability to perform work-related activities.
What information must be reported on ssa 3373?
The SSA-3373 is a form used to gather information about a person's medical condition and how it affects their ability to work. The following information must be reported on the SSA-3373 form:
1. Personal Information: Full name, address, date of birth, Social Security number, contact information, and marital status.
2. Identification of Medical Sources: The names, addresses, and phone numbers of doctors, hospitals, clinics, and other healthcare professionals who have provided treatment or evaluations for the applicant's medical condition(s).
3. Medical History: Details about the applicant's medical condition(s), including the date of onset, symptoms, treatment received, and the impact of the condition on their daily activities and ability to work.
4. Medications: A list of medications prescribed and taken by the applicant, including the dosage and frequency.
5. Medical Tests and Treatment: Information about any medical tests, treatments, surgeries, therapy, and medications taken, along with dates and results, if available.
6. Ability to Function: Descriptions of the limitations and impairments caused by the medical condition(s) in terms of daily activities, physical exertion, mental capabilities, and any special accommodations needed.
7. Work History: A detailed work history, including job titles, dates of employment, job duties, and information about any work-related injuries or illnesses.
8. Education and Training: Educational qualifications, vocational training received, and any certifications or licenses held.
9. Other Information: Any additional information that may help the Social Security Administration evaluate the applicant's claim, such as prior disability claims, workers' compensation claims, or unemployment records.
It is important to provide accurate and detailed information on the SSA-3373 form, as it plays a crucial role in the determination of eligibility for Social Security Disability benefits.
What is the penalty for the late filing of ssa 3373?
The SSA-3373 is a Function Report form used by the Social Security Administration (SSA) to collect information about how a claimant's medical condition affects their ability to work. There is no specific penalty mentioned for the late filing of this form. However, it is always recommended to submit required forms and documentation in a timely manner to avoid delays in processing the claim. It is advisable to reach out to the SSA directly for more information on any potential consequences for late filing.
It's simple with pdfFiller, a full online document management tool. Access our huge online form collection (over 25M fillable forms are accessible) and find the adult function report form in seconds. Open it immediately and begin modifying it with powerful editing options.
How do I complete ssa 3373 bk online?
With pdfFiller, you may easily complete and sign disability function report form online. It lets you modify original PDF material, highlight, blackout, erase, and write text anywhere on a page, legally eSign your document, and do a lot more. Create a free account to handle professional papers online.
How do I fill out the ssa function report adult 06 2020 form on my smartphone?
Use the pdfFiller mobile app to fill out and sign social security administration function form. Visit our website (https://edit-pdf-ios-android.pdffiller.com/) to learn more about our mobile applications, their features, and how to get started.
