Form ssa 3380 bk 12 2009 ef 01 2013-2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, Social Security number, and contact details. Ensure accuracy as this information is crucial for processing.
  3. Proceed to the sections that inquire about your medical conditions. Use the text boxes provided to describe your impairments clearly and concisely. You can also utilize our platform's annotation tools to highlight important details.
  4. In the next section, provide information regarding your daily activities and how your condition affects them. Be specific; this helps in understanding the impact of your disability.
  5. Finally, review all entered information for completeness and accuracy. Utilize our platform’s features to save your progress or share it with others for feedback before submission.

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Third Party Adult Function Report is a form that Social Security sometimes send to your contact person. This form is usually sent out two or three months after you first apply. It is also sometimes used during Continuing Disability Reviews, for people who are already on disability.
Social Security pays five types of benefits: Retirement. Disability. Spouse's/dependent children. Survivors. Medicare.
Yearly earnings totals are free to the public if you do not require certification. To obtain FREE yearly totals of earnings, visit our website at www.ssa.gov/myaccount. Section 205 of the Social Security Act, as amended, allows us to collect this information.

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If SSA reaches out to your contacts, they will receive Form SSA-3380-BK or the Third Party Function Form. This does not mean that there is a problem with your application, but it does mean your case was not clear-cut. The form asks your contacts very detailed questions about your ability to function in daily life.
Be honest but don't 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 isn't that bad and you should have no problem returning to work.
To complete an SSA 3380-BK, you will need to provide the following information: Section A - General Information. ... Section B - Information About Illnesses, Injuries, or Conditions. ... Section C - Information About Daily Activities. ... Section D - Information About Abilities. ... Section E - Remarks. ... Name of person completing the form.
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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