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 document used by the Social Security Administration (SSA) to collect information about an individual's disability. It is the Adult Function Report that helps SSA determine the individual's ability to perform daily activities and work-related tasks. The form gathers details about the person's medical condition, treatments received, and how their disability affects their daily life. It is an essential part of the disability evaluation process.

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 Function Report and the Third Party Adult Function Report. The Adult Function Report is filled out by the individual with the disability, providing their personal insights. The Third Party Adult Function Report, on the other hand, is completed by someone who knows the individual well, such as a family member, friend, or caregiver. Both forms aim to gather comprehensive information about the individual's disability and its impact on their daily functioning and ability to work.

Adult Function Report

Third Party Adult Function Report

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

Completing Form SSA-3373-BK (12-2009) EF (04-2010) requires careful attention to detail. Here are the steps to complete the form:

Start by providing your personal information, such as your name, Social Security number, and contact details.

Next, provide information about your medical condition, including the diagnosis, treatments, and medications you have been receiving.

Describe in detail how your disability affects your ability to perform daily activities, such as personal care, household chores, and mobility.

Explain how your disability impacts your ability to work, including any limitations or challenges you face in performing work-related tasks.

If necessary, attach additional sheets to provide more information or clarify any specific points.

Review the completed form to ensure accuracy and completeness before submitting it to the SSA.

Remember, accurate and detailed information is crucial to help the SSA understand the impact of your disability. If you are unsure about any section of the form, seek assistance from a qualified professional or contact the SSA directly for guidance.

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