SSA-3373 (Formerly SSA-3373-BK) 2024-2025 free printable template

Form SSA3373 (022024) UF Discontinue Prior Editions Social Security AdministrationPage 1 of 10 OMB No. 09600681FUNCTION REPORT ADULT READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM

How to fill out ssa 3373 pdf form

How to fill out form ssa-3373-bk - function

1. Obtain the SSA-3373-BK form from the Social Security Administration website or your local Social Security office.
2. Read the instructions at the beginning of the form carefully to understand what information is required.
3. Fill out personal information, including your name, Social Security number, and contact details.
4. Answer each question honestly and thoroughly, providing detailed information about your condition and how it affects your daily activities.
5. If necessary, use additional sheets of paper to provide more information. Be sure to label each page with your name and Social Security number.
6. Review the completed form for accuracy and completeness.
7. Sign and date the form at the designated area before submitting.
8. Submit the form to the Social Security Administration by mail or in person.

Who needs form ssa-3373-bk - function?

1. Individuals applying for Social Security Disability Insurance (SSDI) benefits who have a medical condition that affects their ability to work.
2. People appealing a decision made by the Social Security Administration regarding their disability status.
3. Those seeking to provide evidence of their functional limitations due to their medical condition.

• Who needs an SSA-3373-BK Form?
• What is an SSA-3373-BK Form Used for?
• Is an SSA-3373-BK Form Accompanied by Other Forms?
• • What Information Should be Provided in an SSA-3373-BK Form?
  • How do I fill out an SSA-3373-BK Form?
  • Where do I send an SSA-3373-BK Form?

Who needs an SSA-3373-BK Form?

People who want to report their illnesses, conditions or injuries limiting their lives should use this form.

What is an SSA-3373-BK Form Used for?

This form is an essential paper while applying for any kind of benefits from the employer or government. While asking for some aid you will automatically explain how your life is limited and how the requested benefit can help you.

Is an SSA-3373-BK Form Accompanied by Other Forms?

An SSA-3373-BK Form is not accompanied by other forms. It doesn't need any attachments as well. If you lack some space while answering some questions you can use a “REMARKS” section on the leis page of the form.

What Information Should be Provided in an SSA-3373-BK Form?

• Disabled person's name

• Social Security Number

• Phone number

• Habitation information

• How do reported circumstances limit your ability to work

• Information about daily activities

• Information about abilities

• Medicines taken

• Etc

How do I fill out an SSA-3373-BK Form?

You shouldn't leave fields blank. If you are not sure about the answer you should either call a Social Security and ask them for help or simply write “Don't know”. This form doesn't require any special knowledge. This is made for you to fill it out on your own. If either the explanation is asked for or you need to explain the answer, be sure to explain the answer. If you need some more space to answer any question, there's “REMARKS” section on the last page for it. Don't forget to write the number of question being answered while using the “REMARKS” section.
Don't write on the “For SSA Use Only” section.

Where do I send an SSA-3373-BK Form?

It is sent to the establishment which made a request for it.

People Also Ask about ssa 3373 form pdf

What is the Social Security 5 year rule?

You must have worked and paid Social Security taxes in five of the last 10 years. • If you also get a pension from a job where you didn't pay Social Security taxes (e.g., a civil service or teacher's pension), your Social Security benefit might be reduced.

Who can fill out form SSA 3373?

After you have made a Social Security Disability claim and have had your initial interview, you may be asked to fill out Form 3373-BK, the Adult Disability Report. This form is designed to be filled out by yourself, without the aid of medical or other professionals.

What is the pain questionnaire for Social Security disability?

The pain questionnaire is asking how pain limits the individual and how often they are experiencing the pain. This form will also ask about any medications they are taking and any side effects the medication is causing. Side effects from medications can also help you show how else your client is limited.

Why did I get form SSA 3373?

DDS requires the completion of the SSA-3373 when they do not have enough information in the medical records to determine whether the person's impairments are keeping them from being able to function in a work environment.

How to fill out the function report for Social Security Disability?

9 tips for filling out the function report Keep your answers consistent. Start with question 20. Answer questions directly. Talk about your average or worst days. Be honest and don't exaggerate. Send additional information as quickly as possible. Talk about all conditions that keep you from working.

Why did I get SSA 3373 form?

Typically, the process of applying for disability begins with you filing an initial claim for benefits and submitting a Form SSA-827 to release your medical records. If those medical records don't provide enough information to make a decision, then the SSA will typically ask you to fill out Form SSA-3373-BK.

What do you say on SSA Form 3373?

Talk about all conditions that keep you from working But only talk about the health conditions that prevent you from working. You may have other conditions that affect your daily life, but the SSA doesn't need to hear about them on this form.

Who fills out SSA 3373?

After you have made a Social Security Disability claim and have had your initial interview, you may be asked to fill out Form 3373-BK, the Adult Disability Report. This form is designed to be filled out by yourself, without the aid of medical or other professionals.

Should I worry about a continuing disability review?

Should I Worry about a Continuing Disability Review? Generally, you should not worry about a Continuing Disability Review if you're still disabled and can not work. However, if your disability has improved or resolved entirely, the SSA may terminate your disability benefits.

How long can you pay attention to SSA 3373?

You only have a limited time to comply (10 days from the date of the letter) with Social Security's request so don't delay. But, don't rush through your answers either. Your Adult Function Report, also known as SSA 3373, stays on the record through your entire case and cannot be modified.

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What is form ssa-3373-bk - function?

Form SSA-3373-BK is a Disability Report - Adult, which is used by the Social Security Administration to collect information about the functional abilities of individuals applying for disability benefits.

Who is required to file form ssa-3373-bk - function?

Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits may be required to file Form SSA-3373-BK to assess their functionality.

How to fill out form ssa-3373-bk - function?

To fill out Form SSA-3373-BK, individuals need to provide detailed information about their medical conditions, how these conditions affect their daily activities, and any treatments received.

What is the purpose of form ssa-3373-bk - function?

The purpose of Form SSA-3373-BK is to evaluate the applicant's ability to perform daily activities and work-related tasks to determine eligibility for disability benefits.

What information must be reported on form ssa-3373-bk - function?

The form requires reporting medical conditions, limitations in daily activities, treatment history, and how the disability affects the ability to work.