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Blank SSA SSA-3373-BK Form

The SSA SSA-3373-BK form is a crucial document used by the Social Security Administration to assess an individual's ability to work due to their medical condition. This form gathers detailed information about a person's daily activities, limitations, and health issues. Completing it accurately is essential for ensuring that the application for disability benefits is properly evaluated.

Outline

The SSA-3373-BK form, also known as the Function Report – Adult, plays a crucial role in the Social Security Administration's evaluation process for disability claims. This form is designed to gather comprehensive information about an individual's daily activities, functional limitations, and overall ability to perform basic tasks. Claimants are asked to provide detailed accounts of how their conditions affect their daily lives, including personal care, social interactions, and the ability to engage in work-related activities. The information collected through this form helps the SSA assess the severity of a claimant's disability and determine eligibility for benefits. It is important for individuals completing the SSA-3373-BK to provide accurate and thorough responses, as this documentation can significantly influence the outcome of their claims. Understanding the purpose and requirements of the form is essential for anyone seeking Social Security Disability Insurance or Supplemental Security Income benefits.

Sample - SSA SSA-3373-BK Form

Form SSA-3373 (02-2024) UF
Discontinue Prior Editions	Page 1 of 10
Social Security Administration	OMB No. 0960-0681

FUNCTION REPORT - ADULT

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. If you need the address or phone number for the office that provided the form, you can get it by calling Social Security at 1-800-772-1213.

HOW TO COMPLETE THIS 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. If you do not know the answer or the answer is "none" or "does not apply," please write "don't know" or "none" or "does not apply."

•Do not ask a doctor or hospital to complete this form.

•Be sure to explain an answer if the question asks for an explanation, or if you think you need to explain an answer.

•If more space is needed to answer any questions, use the "REMARKS" section on Page 10, and show the number of the question being answered.

•If a specific activity is performed with the help of others, please indicate that.

Function Report - Adult - Form SSA-3373-BK

REMEMBER TO GIVE US THE NAME AND ADDRESS OF THE PERSON

COMPLETING THIS FORM ON PAGE 10

Form SSA-3373 (02-2024) UF

Page 2 of 10

Privacy Act Statements

Collection and Use of Personal Information

Sections 205(a), 223(d), and 1631 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on any claim filed.

We will use the information you provide to determine benefits eligibility. We may also share the information for the following purposes, called routine uses:

•To third party contacts (e.g., employers and private pension plans) in situations where the party to be contacted has, or is expected to have, information relating to the individual's capability to manage his or her benefits or payments, or his or her eligibility for entitlement to benefits or eligibility for payments, under the Social Security program; and

•To contractors and other Federal agencies, as necessary, for the purpose of assisting the Social Security Administration (SSA) in the efficient administration of its programs. We will disclose information under this routine use only in situations in which we may enter into a contractual or similar agreement to obtain assistance in accomplishing an SSA function relating to this system record.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422, and 60-0320, entitled Electronic Disability Claim File, as published in the FR on June 6, 2020 at 85 FR 34477. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 61 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO

YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S.

Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments regarding this burden

estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to

our time estimate or other aspects of this collection to this address, not the completed form.

PLEASE REMOVE THIS SHEET BEFORE RETURNING

THE COMPLETED FORM.

Form SSA-3373 (02-2024) UF
Discontinue Prior Editions	Page 3 of 10
Social Security Administration	OMB No. 0960-0681

FUNCTION REPORT - ADULT

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 or fails to disclose an event with an intent to affect an initial or continued right to payment, commits a crime punishable under Federal law by fine, imprisonment, or both, and may be subject to administrative sanctions.

SECTION A - GENERAL INFORMATION

1. NAME OF DISABLED PERSON (First, Middle Initial, Last)

2. SOCIAL SECURITY NUMBER

3.YOUR DAYTIME TELEPHONE NUMBER (If there is no telephone number where you can be reached, please give us a daytime number where we can leave a message for you.)

Your Number

Message Number

None

Area Code Phone Number

4. a. Where do you live? (Check one.)

House	Apartment	Boarding House	Nursing Home
Shelter	Group Home	Other (What?)

b. With whom do you live? (Check one.)

Alone

With Family

With Friends

Other (Describe relationship.)

SECTION B - INFORMATION ABOUT YOUR ILLNESSES, INJURIES, OR CONDITIONS

5.How do your illnesses, injuries, or conditions limit your ability to work?

____________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 4 of 10

SECTION C - INFORMATION ABOUT DAILY ACTIVITIES

6.Describe what you do from the time you wake up until going to bed.

____________________________________________________________________________________________________


7. Do you take care of anyone else such as a wife/husband, children, grandchildren,	Yes	No
parents, friend, other?	Yes	No
parents, friend, other?
If "YES," for whom do you care, and what do you do for them?

8. Do you take care of pets or other animals?			Yes	No
If "YES," what do you do for them?

9. Does anyone help you care for other people or animals?
If "YES," who helps, and what do they do to help?			Yes	No

10.	What were you able to do before your illnesses, injuries, or conditions that you can't do now?

11.	Do the illnesses, injuries, or conditions affect your sleep?		Yes	No
If "YES," how?

12.	PERSONAL CARE (Check here	if NO PROBLEM with personal care.)
a. Explain how your illnesses, injuries, or conditions affect your ability to:
Dress

Bathe

Care for hair

Shave

Feed self

Use the toilet

Other

Form SSA-3373 (02-2024) UF		Page 5 of 10

b. Do you need any special reminders to take care of personal	Yes	No
needs and grooming?	Yes	No
If "YES," what type of help or reminders are needed?

__________________________________________________________________________________________________

c. Do you need help or reminders taking medicine?

Yes

If "YES," what kind of help do you need?

__________________________________________________________________________________________________

13. MEALS
a. Do you prepare your own meals?	Yes	No

If "Yes," what kind of food do you prepare? (For example, sandwiches, frozen dinners, or complete meals with several courses.)

__________________________________________________________________________________________________

How often do you prepare food or meals? (For example, daily, weekly, monthly.)

How long does it take you?

Any changes in cooking habits since the illness, injuries, or conditions began?

b. If "No," explain why you cannot or do not prepare meals.

__________________________________________________________________________________________________

14.HOUSE AND YARD WORK

a.List household chores, both indoors and outdoors, that you are able to do. (For example, cleaning, laundry, household repairs, ironing, mowing, etc.)

__________________________________________________________________________________________________

b. How much time does it take you, and how often do you do each of these things?

c. Do you need help or encouragement doing these things?	Yes	No
If "YES," what help is needed?

d. If you don't do house or yard work, explain why not.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 6 of 10

15.GETTING AROUND

a. How often do you go outside?

If you don't go out at all, explain why not.

__________________________________________________________________________________________________

b.	When going out, how do you travel? (Check all that apply.)
	Walk	Drive a car	Ride in a car	Ride a bicycle
	Use public transportation		Other (Explain)
c. When going out, can you go out alone?				Yes	No

If "NO," explain why you can't go out alone.

__________________________________________________________________________________________________

d. Do you drive?

Yes

If you don't drive, explain why not.

__________________________________________________________________________________________________

16.SHOPPING

a. If you do any shopping, do you shop: (Check all that apply.)

In stores

By phone

By mail

By computer

b. Describe what you shop for.

c. How often do you shop and how long does it take?

__________________________________________________________________________________________________


17. MONEY
a. Are you able to:
	Pay bills	Yes	No	Handle a savings account	Yes	No
	Count change	Yes	No	Use a checkbook/money orders	Yes	No
	Explain all "NO" answers.

b. Has your ability to handle money changed since the illnesses,					Yes	No
injuries, or conditions began?

If "YES," explain how the ability to handle money has changed.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 7 of 10

18.HOBBIES AND INTERESTS

a. What are your hobbies and interests? (For example, reading, watching TV, sewing, playing sports, etc.)

__________________________________________________________________________________________________

b. How often and how well do you do these things?

__________________________________________________________________________________________________

c. Describe any changes in these activities since the illnesses, injuries, or conditions began.

__________________________________________________________________________________________________

19.SOCIAL ACTIVITIES

a. How do you spend time with others? (Check all that apply.)

In person	On the phone	Email	Texting		Mail
Video Chat (for example Skype or Facetime)			Other (Explain)

b. Describe the kinds of things you do with others.

__________________________________________________________________________________________________

How often do you do these things?

c. List the places you go on a regular basis. (For example, church, community center, sports events, social groups, etc.)

__________________________________________________________________________________________________

Do you need to be reminded to go places?	Yes	No
How often do you go and how much do you take part?

Do you need someone to accompany you?	Yes	No

If "YES", explain.

__________________________________________________________________________________________________

d. Do you have any problems getting along with family, friends, neighbors, or others?	Yes	No
If "YES," explain.

__________________________________________________________________________________________________

e. Describe any changes in social activities since the illnesses, injuries, or conditions began.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 8 of 10

SECTION D - INFORMATION ABOUT ABILITIES

20. a. Check any of the following items that your illnesses, injuries, or conditions affect:

Lifting	Walking	Stair Climbing	Understanding
Squatting	Sitting	Seeing	Following Instructions
Bending	Kneeling	Memory	Using Hands
Standing	Talking	Completing Tasks	Getting Along With Others
Reaching	Hearing	Concentration

Please explain how your illnesses, injuries, or conditions affect each of the items you checked. (For example, you can only lift [how many pounds], or you can only walk [how far])

__________________________________________________________________________________________________

b. Are you:

Right Handed?

Left Handed?

c. How far can you walk before needing to stop and rest?

If you have to rest, how long before you can resume walking?

__________________________________________________________________________________________________

d. For how long can you pay attention?


e. Do you finish what you start? (For example, a conversation, chores,	Yes	No
reading, watching a movie.)	Yes	No
reading, watching a movie.)

f. How well do you follow written instructions? (For example, a recipe.)

__________________________________________________________________________________________________

g. How well do you follow spoken instructions?

__________________________________________________________________________________________________

h. How well do you get along with authority figures? (For example, police, bosses, landlords or teachers.)

__________________________________________________________________________________________________

i. Have you ever been fired or laid off from a job because of problems getting	Yes	No
along with other people?

If "YES," please explain.

__________________________________________________________________________________________________

If "YES," please give name of employer.

Form SSA-3373 (02-2024) UF

Page 9 of 10

j. How well do you handle stress?

k. How well do you handle changes in routine?

l. Have you noticed any unusual behavior or fears?

Yes

If "YES," please explain.

__________________________________________________________________________________________________

21. Do you use any of the following? (Check all that apply.)
Crutches	Cane	Hearing Aid
Walker	Brace/Splint	Glasses/Contact Lenses
Wheelchair	Artificial Limb	Artificial Voice Box
Other (Explain)

Which of these were prescribed by a doctor?

__________________________________________________________________________________________________

When was it prescribed?

__________________________________________________________________________________________________

When do you need to use these aids?

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF		Page 10 of 10

22. Do you currently take any medicines for your illnesses, injuries, or conditions?	Yes	No
If "YES, "do any of your medicines cause side effects?	Yes	No

If "YES," please explain. (Do not list all of the medicines that you take. List only the medicines that cause side effects.)

NAME OF MEDICINE

SIDE EFFECTS YOU HAVE

SECTION E - REMARKS

Use this section for any added information you did not show in earlier parts of this form. When you are done with this section (or if you didn't have anything to add), be sure to complete the fields at the bottom of this page.

______________________________________________________________________________________________________

Name of person completing this form (Please print)

Date (MM/DD/YYYY)

Address (Number and Street)

Email address (optional)

City

State

ZIP Code

Click for PDF

Form Information

Fact Name	Details
Purpose	The SSA-3373-BK form is used to collect information about a person's daily activities and limitations due to their medical condition.
Who Uses It	This form is primarily used by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Sections	The form includes sections on work history, daily activities, and how conditions affect daily living.
Submission	The completed form must be submitted to the Social Security Administration (SSA) as part of the disability application process.
Importance	Accurate and thorough completion of this form can significantly impact the outcome of a disability claim.
State-Specific Forms	Some states may have additional forms or requirements based on local laws regarding disability claims.
Governing Laws	The SSA-3373-BK is governed by federal laws under the Social Security Act, but state-specific laws may also apply.
Assistance	Applicants can seek help from legal advisors or disability advocates when filling out the form to ensure accuracy.

Detailed Guide for Filling Out SSA SSA-3373-BK

Filling out the SSA-3373-BK form is an important step in the process of applying for Social Security benefits. This form requires detailed information about your daily activities and limitations. Completing it accurately helps ensure that your application reflects your situation clearly and effectively.

Begin by gathering necessary personal information, including your name, Social Security number, and contact details.
Read each section of the form carefully before you start filling it out. This will help you understand what information is required.
In the first section, describe your medical conditions. Be specific about each condition and how it affects your daily life.
Next, provide information about your daily activities. Think about tasks you can do independently and those you need assistance with.
In the following section, detail any medications you take. Include the name, dosage, and purpose of each medication.
Continue by discussing any treatments or therapies you undergo. Explain how these impact your daily life and functionality.
Next, focus on your work history. List your past jobs, including the type of work you did and how long you worked in each position.
Complete the section on your education and training. Include any relevant skills or qualifications you have acquired.
Finally, review the entire form for accuracy. Make sure all information is complete and truthful before submitting it.

Once you have filled out the SSA-3373-BK form, the next step is to submit it to the Social Security Administration. This can often be done online, by mail, or in person at your local office. Be sure to keep a copy for your records.

Obtain Answers on SSA SSA-3373-BK

What is the SSA-3373-BK form?

The SSA-3373-BK form, also known as the "Function Report - Adult," is a document used by the Social Security Administration (SSA) to gather information about an individual's daily activities, capabilities, and limitations. This form plays a crucial role in determining eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Who needs to fill out the SSA-3373-BK form?

Individuals applying for SSDI or SSI benefits may be required to complete the SSA-3373-BK form. This includes those who have a medical condition that significantly affects their ability to work or perform daily tasks. The information provided helps the SSA assess the extent of the disability.
How do I obtain the SSA-3373-BK form?

The SSA-3373-BK form can be obtained directly from the SSA's official website. It is also available at local SSA offices. If you prefer, you may request a paper copy by contacting the SSA or visiting your nearest office.
What information is required on the SSA-3373-BK form?

The form asks for detailed information about your daily activities, including:
- Your ability to perform household tasks
- Social interactions and relationships
- Work-related activities and limitations
- Hobbies and interests
- Any assistance you may require
This information helps the SSA understand how your condition impacts your life.
How should I complete the SSA-3373-BK form?

When filling out the form, be honest and thorough. Describe your daily activities in detail, noting any difficulties you encounter. Use specific examples to illustrate how your condition affects your life. It may be helpful to have someone assist you in completing the form if needed.
Can I get help with the SSA-3373-BK form?

Yes, assistance is available. You can seek help from family members, friends, or professionals who are familiar with the disability application process. Additionally, organizations that advocate for individuals with disabilities may provide resources and guidance.
What happens after I submit the SSA-3373-BK form?

Once the form is submitted, the SSA will review the information along with your medical records and other documentation. This review process determines your eligibility for benefits. You may be contacted for additional information or clarification if needed.
How long does it take to process the SSA-3373-BK form?

The processing time can vary. Generally, it may take several weeks to months for the SSA to review your application and make a decision. Factors such as the complexity of your case and the volume of applications being processed can influence this timeline.
What if I disagree with the SSA's decision after submitting the form?

If you disagree with the decision regarding your application, you have the right to appeal. The SSA provides a clear process for appeals, which includes submitting a request for reconsideration. It's important to follow the outlined steps and provide any additional evidence that supports your case.
Is there a deadline for submitting the SSA-3373-BK form?

While there is no specific deadline for submitting the SSA-3373-BK form itself, it is essential to submit it as part of your overall application for disability benefits. Delays in submission may impact the processing of your application, so it is advisable to complete it promptly.

Common mistakes

Filling out the SSA SSA-3373-BK form can be a daunting task, and many individuals make common mistakes that can hinder their application process. One frequent error is not providing enough detail about daily activities. This form requires a comprehensive understanding of how your condition affects your everyday life. Be specific about limitations and challenges you face.

Another mistake is underestimating the impact of symptoms. Some people may think that their symptoms are not severe enough to warrant attention. However, even minor limitations can significantly affect your ability to work. It is crucial to describe all symptoms accurately and how they interfere with daily tasks.

Many applicants also fail to include all relevant medical information. Omitting details about treatments, medications, or doctor visits can lead to incomplete evaluations. Ensure you provide a complete medical history, including all healthcare providers involved in your care.

In addition, some individuals do not take the time to review their answers before submission. This can lead to simple errors or inconsistencies that could raise questions during the review process. Double-checking your responses can help avoid unnecessary delays.

Another common oversight is neglecting to explain how conditions affect social interactions. The SSA is interested in understanding not just physical limitations but also how your condition impacts relationships and social activities. Be sure to address these aspects in your responses.

Some applicants may also forget to sign and date the form. A missing signature can lead to the rejection of the application. Always confirm that you have signed and dated the form before submitting it.

Lastly, failing to keep a copy of the completed form can be problematic. If questions arise later or if you need to reference your application, having a copy will be invaluable. Maintain a record of all submitted documents for your own reference.

Documents used along the form

The SSA SSA-3373-BK form is an important document used in the Social Security Administration's disability evaluation process. However, it is often accompanied by other forms and documents that help provide a comprehensive picture of an individual's situation. Here’s a list of related forms that you may need to consider.

SSA-16: This form is used to apply for Social Security Disability Insurance (SSDI) benefits. It collects information about your work history and earnings.
SSA-827: This is a medical release form that allows the SSA to obtain your medical records from healthcare providers. It's essential for verifying your disability claim.
SSA-3368: This form gathers information about your medical conditions, treatments, and how they affect your daily life. It's crucial for understanding the severity of your disability.
SSA-3375: Used to report changes in your work activity, this form helps keep your disability claim up to date with any new employment information.
Form 3369: This is a Work History Report. It provides detailed information about your past jobs, duties, and how your disability impacts your ability to work.
Form 827: This form is a consent to release information. It allows the SSA to gather necessary details from third parties, like employers or family members, to support your claim.
Form SSA-451: This form is used for reporting any changes in your medical condition or living situation that could affect your eligibility for benefits.

Understanding these related forms can streamline the application process and enhance your chances of receiving the benefits you deserve. Ensure you gather all necessary documents to present a strong case for your disability claim.

Similar forms

The SSA-3373-BK form, also known as the Function Report, is a crucial document used by the Social Security Administration (SSA) to assess an individual's ability to perform daily activities and work-related tasks. Several other forms and documents serve similar purposes in evaluating functional limitations and disability claims. Here’s a list of nine documents that share similarities with the SSA-3373-BK form:

SSA-3368-BK (Disability Report - Adult): This form collects information about the applicant's medical conditions, treatments, and how these affect their daily life and ability to work.
SSA-827 (Authorization to Disclose Information to the Social Security Administration): This document allows the SSA to obtain medical records and other relevant information, which is essential for understanding the applicant's functional limitations.
SSA-3375 (Work History Report): Similar to the SSA-3373-BK, this form details the applicant's past work experience and how their disabilities impact their ability to perform those jobs.
SSA-3367 (Function Report - Adult): This report is focused specifically on the applicant's daily activities, social interactions, and any challenges faced due to their impairments.
Form SSA-3820 (Request for Reconsideration): When a claim is denied, this form allows applicants to provide additional evidence, including functional reports, to support their case.
Form SSA-2506 (Disability Report - Child): For applicants under 18, this form assesses similar functional limitations and daily activities as the SSA-3373-BK but tailored for children.
Form SSA-827 (Authorization to Disclose Information): This document is crucial in gathering medical evidence, similar to how the SSA-3373-BK aims to gather information about daily functioning.
Form SSA-16 (Application for Disability Insurance Benefits): This application requires information about the applicant's medical conditions and their impact on work, much like the SSA-3373-BK.
Form SSA-454 (Continuing Disability Review Report): This form is used to evaluate ongoing eligibility for benefits, assessing how a claimant's functional capacity may have changed over time.

Understanding these forms and their purposes can help applicants navigate the disability claims process more effectively. Each document plays a role in painting a comprehensive picture of an individual's functional abilities and limitations.

Dos and Don'ts

When filling out the SSA SSA-3373-BK form, it’s crucial to be thorough and accurate. This form plays a significant role in determining eligibility for Social Security Disability benefits. Here’s a list of things you should and shouldn’t do to ensure your application is processed smoothly.

Do read the instructions carefully before starting the form.
Do provide detailed information about your medical conditions.
Do include all relevant dates, such as when your condition began.
Do check your form for any errors before submitting.
Don’t leave any questions unanswered; incomplete forms can delay processing.
Don’t exaggerate or minimize your symptoms; honesty is crucial.

By following these guidelines, you can help ensure that your SSA SSA-3373-BK form is completed accurately, increasing the chances of a favorable outcome.

Misconceptions

The SSA-3373-BK form, also known as the Adult Function Report, is an important document used by the Social Security Administration (SSA) to assess an individual's ability to function in daily life. However, several misconceptions exist regarding this form. Below is a list of seven common misconceptions and clarifications about the SSA-3373-BK form.

Misconception 1: The SSA-3373-BK form is only for individuals applying for Social Security Disability Insurance (SSDI).

This form is used for both SSDI and Supplemental Security Income (SSI) applications. It helps evaluate the functional limitations of applicants regardless of the program.

Misconception 2: Completing the form is optional.

While it may seem optional, submitting the SSA-3373-BK form is highly recommended. It provides critical information that can influence the outcome of a claim.

Misconception 3: The form must be filled out by a healthcare professional.

Applicants can complete the SSA-3373-BK form themselves. However, they may choose to seek assistance from healthcare providers or advocates to ensure accuracy.

Misconception 4: The form only asks about physical limitations.

The SSA-3373-BK form addresses both physical and mental limitations. It covers various aspects of daily living, including social interactions and cognitive abilities.

Misconception 5: Providing too much detail on the form is unnecessary.

Providing detailed and specific information is crucial. The SSA uses this information to assess how impairments affect daily activities and overall functioning.

Misconception 6: The form is not important for the appeal process.

In the event of a denied claim, the SSA-3373-BK form can be critical during the appeals process. It serves as a record of the applicant’s functional limitations.

Misconception 7: Once submitted, the information cannot be updated.

Applicants can update the information on the SSA-3373-BK form if their condition changes or if they realize they need to provide additional details. Communication with the SSA is key.

Key takeaways

The SSA-3373-BK form, also known as the Adult Function Report, is an important document for individuals applying for Social Security Disability benefits. Here are some key takeaways to keep in mind when filling out and using this form:

Detailed Descriptions Matter: Provide thorough and specific descriptions of how your condition affects your daily life. This includes activities such as cooking, cleaning, and socializing.
Be Honest and Accurate: It’s crucial to be truthful about your limitations and capabilities. Overstating or understating your condition can impact the decision on your application.
Include Supportive Information: If possible, attach additional documents or statements from healthcare providers that can support your claims about your limitations.
Review Before Submission: Double-check your form for completeness and accuracy. A well-prepared form can significantly influence the outcome of your application.

By keeping these points in mind, you can enhance your chances of a successful application for Social Security Disability benefits.