Form ssa 3373 bk fillable 2004-2026

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The document is a guide for completing the Function Report - Adult (Form SSA-3373-BK) required by the Social Security Administration to assess an individual's disability claim. It provides instructions on how to fill out the form, emphasizing the importance of detailing daily activities, abilities, and limitations due to illnesses or conditions. The form collects personal information, daily routines, social interactions, and any assistance needed in various aspects of life. It also includes privacy statements regarding the use of provided information.

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Click ‘Get Form’ to open the SSA-3373-BK in the editor.
Begin with Section A, where you will provide general information about the disabled person, including their name, Social Security number, and contact details.
Move to Section B to describe daily activities. Answer questions regarding personal care, meal preparation, household chores, and social activities. Be thorough in your responses.
In Section C, check any items that your conditions affect and provide explanations for each. This section is crucial for detailing how your abilities are impacted.
Utilize the 'REMARKS' section on Page 8 for any additional information or clarifications needed for previous answers.
Finally, ensure you complete the fields at the bottom of Page 8 with your name and address before submitting the form.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (47 Votes)
2020	4.4 Satisfied (108 Votes)
2015	4.4 Satisfied (98 Votes)
2013	4.1 Satisfied (67 Votes)
2009	4.2 Satisfied (122 Votes)
2007	4 Satisfied (41 Votes)
2004	4 Satisfied (21 Votes)

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ssa 3373 bk printable form

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