Form Ssa-3373-bk (12-2009) Ef (04-2010)

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What is form ssa-3373-bk (12-2009) ef (04-2010)?

Form SSA-3373-BK (12-2009) EF (04-2010) is a form used by the Social Security Administration (SSA) to collect information about an individual's medical condition and how it affects their ability to work. It helps the SSA determine if the individual is eligible for disability benefits.

What are the types of form ssa-3373-bk (12-2009) ef (04-2010)?

There are two types of Form SSA-3373-BK (12-2009) EF (04-2010): the Adult Form and the Pediatric Form. The Adult Form is used for individuals aged 18 and older, while the Pediatric Form is used for individuals under the age of 18. Both forms collect similar information about the individual's medical condition and its impact on their ability to work.

Adult Form

Pediatric Form

How to complete form ssa-3373-bk (12-2009) ef (04-2010)

To complete Form SSA-3373-BK (12-2009) EF (04-2010), follow these steps:

Provide personal information such as your name, Social Security number, and contact information.

Answer detailed questions about your medical condition, including symptoms, diagnoses, and treatment received.

Indicate how your medical condition affects your ability to work, including any limitations you experience.

Provide information about your work history, including previous jobs and the demands of those jobs.

Include any supporting documentation, such as medical records, that can help support your claim for disability benefits.

Review the completed form for accuracy and sign it.

Submit the form to the Social Security Administration either online or by mail.

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