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Form ssa 3373 bk 2010-2026

The document is a Function Report - Adult (Form SSA-3373-BK) used by the Social Security Administration to gather information about an individual's disabilities and how they affect daily activities and work capabilities. It provides instructions for completing the form, emphasizes the importance of detailed responses, and outlines the types of information required regarding personal care, household tasks, social activities, and limitations due to illnesses or conditions.

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Click ‘Get Form’ to open it in the editor.
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.
Move to Section B, detailing how illnesses or conditions limit work abilities. Be specific in your descriptions to aid the decision-making process.
In Section C, describe daily activities from waking up to going to bed. Include any caregiving responsibilities and how these have changed due to health issues.
Proceed to Section D, where you will check items affected by your conditions and explain how they impact your daily life. This section is crucial for illustrating limitations.
Finally, use the Remarks section on Page 8 for any additional information that may not have been covered earlier. Remember to include your name and address before submitting.

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Who can fill 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.

What is a function Report adult third party?

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.

What are the 3 main types of Social Security benefits?

Social Security pays five types of benefits: Retirement. Disability. Spouse's/dependent children. Survivors. Medicare.