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The document is the Function Report - Adult - Third Party Form SSA-3380-BK, used by the Social Security Administration to gather information about a disabled person's activities and limitations from a third party. It outlines instructions for completion, privacy statements, and various sections that inquire about the disabled person's daily activities, personal care, social interactions, and abilities. The information collected is essential for determining eligibility for disability benefits.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (57 Votes)
2020	4.3 Satisfied (33 Votes)
2017	4.3 Satisfied (157 Votes)
2015	4.3 Satisfied (27 Votes)
2009	4.4 Satisfied (82 Votes)
2004	4 Satisfied (37 Votes)
2003	4 Satisfied (28 Votes)

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What is SSA 821 BK form?

Social Security uses the Work Activity Report form to learn more about the work activity of a disability applicant or beneficiary. If you are applying for disability benefits, the information you provide will help us decide if you can receive benefits.

How do you fill out a BSA 3380 BK?

How to complete an SSA 3380 BK (Step by Step) Name of disabled person. Name of person completing form. Relationship. Date. Daytime telephone number. Length of time youve known the person. Amount of time you spend with the disabled person. Location where the disabled person lives.

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.

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Can you submit SSA forms online?

You can complete an application for Retirement, Spouses, Medicare or Disability Benefits online. If you cannot submit your application online: You can call us at 1-800-772-1213 (TTY 1-800-325-0778); or. Due to the COVID-19 pandemic, visits to our offices are by appointment only for certain services.

How do I submit a form to Social Security?

You can apply: Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.

How do I fill out an adult function report?

Be honest but dont exaggerate. Be specific about your limitations. If you do not clearly describe your limitations or give vague answers on your Adult Function Report, Social Security will take that to mean your disability really isnt that bad and you should have no problem returning to work.

How do you answer Question 6 on a function report?

Question 6 of the SSD Function Report can be tricky. It asks you to describe what you do from the time you wake up until you go to bed at night. Most people with disabilities have good days and bad days. Make sure you clearly identify and describe what you do on a good day and on a bad day.

Can I mail forms to Social Security?

If you download, print and complete a paper form, please mail or take it to your local Social Security office or the office that requested it from you. Important Note: PDFs you open from this page may default to opening within a browser, depending on your browser settings.

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