Form ssa 3373 bk 2010-2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section A, where you will provide general information about the disabled person, including their name and Social Security number. Ensure all fields are filled accurately.
  3. Move to Section B, detailing the illnesses or conditions affecting the individual. Clearly describe how these impact their ability to work.
  4. In Section C, outline daily activities. Describe routines from waking up to going to bed, including personal care and household tasks.
  5. Proceed to Section D, where you will check any abilities affected by the conditions. Provide explanations for each checked item.
  6. Finally, use Section E for any additional remarks or information that may assist in understanding the individual's situation.

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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.
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.
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Social Security Form SSA-3373-BK is a lengthy form that you fill out as a part of the process of applying for Social Security Disability benefits. It also goes by the Adult Disability Report or the Adult Function Report.
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.
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.

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