Ssa 3373 Bk Printable Form Forms All forms are FREE Not all forms are listed If you can t find the form you need or you need help completing a form please call us at 1 800 772 1213 TTY 1 800 325 0778 or contact your local Social Security office and we will help you
FUNCTION REPORT ADULT Form SSA 3373 BK If you need help with this form complete as much of it as you can and call the phone number provided on the letter sent with the form or contact the person who asked you to complete the form If you need the address or phone number for the office that provided the form you can get it by calling Use the SSA 3373 to collect information about a claimant s ability to function and to perform the activities of daily living The information detailed on the SSA 3373 may be obtained by telephone and recorded on an SSA 5002 in lieu of using the SSA 3373 Supplemental information may be added to the SSA 3373 B Procedure 1 When to Complete
Ssa 3373 Bk Printable Form
Ssa 3373 Bk Printable Form
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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 Legal Forms Form Ssa 3373 Bk Form Ssa 3373 Bk Create My Document Form SSA 3373 BK is used to report an adult individual s ability to function The Adult Function Report is used by the Social Security Administration as part of the criteria used to determine whether an individual qualifies to receive disability payments
The SSA 3368 is used for title II and title XVI disability or blindness claims Reviewers obtain basic information on an adult claimant s medical conditions medical treatment including sources of medical evidence and any other information needed to process the claim to a decision The form also reserves the claimant s protective filing FUNCTION REPORT ADULT Form SSA 3373 BK If you need help with this form complete as much of it as you can and call the phone number provided on the letter sent with the form or contact the person who asked you to complete the form If you need the address or phone number for the office that provided the form you can get it by calling
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FUNCTION REPORT ADULT Form SSA 3373 BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form complete as much of it as you can and call the phone number provided on the letter sent with the form or contact the person who asked you to complete the form FUNCTION REPORT ADULT Form Approved OMB No 0960 0681 How your illnesses injuries or conditions limit your activities For SSA Use Only Do not write in this box Anyone who makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act or knowingly conceals
Library Tools About the Function Report SSA 3373 The SSA has an optional form called the Function Report that DDS uses when they are in need of additional information about how an applicant is able to function in everyday life They will often refer to the form as The ADLs or the ADL questionnaire They are referring to In this article s next section I will review some of the questions asked on Form SSA 3373 BK and how to answer them But first let s start with some general recommendations 1 Keep a Diary of All Your Activities for Three Days Before Completing the Disability Function Report Form SSA 3373 BK asks many questions about how you spend your
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Forms All forms are FREE Not all forms are listed If you can t find the form you need or you need help completing a form please call us at 1 800 772 1213 TTY 1 800 325 0778 or contact your local Social Security office and we will help you
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FUNCTION REPORT ADULT Form SSA 3373 BK If you need help with this form complete as much of it as you can and call the phone number provided on the letter sent with the form or contact the person who asked you to complete the form If you need the address or phone number for the office that provided the form you can get it by calling
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Ssa 3373 Bk Printable Form - The information that you give us on this form will be used by the office that makes the disability decision on your disability claim You can help them by completing as much of the form as you can It is important that you tell us about your activities and abilities Print or type DO NOT LEAVE ANSWERS BLANK
