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Free SSA SSA-3373-BK PDF Template

The SSA SSA-3373-BK form, commonly known as the Function Report - Adult, plays a crucial role in the Social Security disability benefits application process. This document is designed to provide the Social Security Administration (SSA) with detailed insights into how an individual's disability affects their daily activities and capabilities. The completion of this form is a vital step for applicants to convey the extent of their limitations and to support their claim for disability benefits.

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Outline

When navigating the labyrinth of documentation required for securing social security benefits due to disability, one encounters various forms, each playing a crucial role in the adjudicative process. Among these, the SSA-3373-BK form, also known as the Adult Disability Report, stands out as particularly significant. This form is instrumental in providing the Social Security Administration (SSA) with a comprehensive understanding of how an individual's disability affects their daily life and their capacity to engage in work. It seeks detailed information on medical conditions, treatment history, work activity, and the impact of the disability on everyday activities. By meticulously assembling this data, the SSA-3373-BK form bridges the gap between the clinical aspects of a disability and its real-world implications, enabling a nuanced assessment of each case. As such, the completion of this form with accuracy and thoroughness cannot be overstated for applicants seeking to establish their eligibility for benefits. Moreover, it underscores the importance of clear communication between applicants and the SSA, serving as a critical tool in the evaluative process that determines the provision of much-needed support to individuals facing significant challenges.

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Form SSA-3373 (10-2020)
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.

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 (10-2020)	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 make a determination of eligibility for benefits. We may also share your information for the following purposes, called routine uses:

•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; and

•To applicants, claimants, prospective applicants or claimants, other than the data subject, their authorized representatives or representative payees to the extent necessary to pursue Social Security claims and to representative payees when the information pertains to individuals for whom they serve as representative payees, for the purpose of assisting SSA in administering its representative payment responsibilities under the Act and assisting the representative payees in performing their duties as payees, including receiving and accounting for benefits for individuals for whom they serve as payees.

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 April 1, 2003, at FR 15784, and 60-0320, entitled Electronic Disability Claim File, as published in the FR on December 22, 2003, at 68 FR 71210. Additional information, and a full listing of all our SORNs, is available on our website at https://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 to this address, not the completed form.

PLEASE REMOVE THIS SHEET BEFORE RETURNING

THE COMPLETED FORM.

Form SSA-3373 (10-2020)
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 (10-2020)

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.
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 (10-2020)			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	No
	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 (10-2020)	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?

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

d. Do you drive?

If you don't drive, explain why not.

16.SHOPPING

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

Yes

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 (10-2020)	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.)

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

Do you need someone to accompany you?

If "YES", explain.

d. Do you have any problems getting along with family, friends, neighbors, or others? If "YES," explain.

Yes

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

Form SSA-3373 (10-2020)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 (10-2020)	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	No
	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 (10-2020)	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)

Address (Number and Street)

Date (MM/DD/YYYY)

Email address (optional)

City

State

ZIP Code

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Document Attributes

Fact Name	Description
Form Purpose	The SSA-3373-BK form, also known as the Function Report - Adult, is used by the Social Security Administration (SSA) to gather detailed information about how someone's disability affects their daily activities and capabilities.
Who Completes It	This form is typically completed by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) based on disability.
Sections Included	The form includes sections on daily activities, personal care, meal preparation, shopping, mobility, and other areas relevant to assessing the impact of the disability.
Importance of Accuracy	Accurate and detailed responses are crucial as they can significantly influence the outcome of the disability benefits application process.
Supporting Documents	Applicants may be asked to support their responses with additional documents or records that verify their condition and its impact on their daily life.
Governing Law	The SSA-3373-BK form is governed by federal law, as the SSA is a federal agency. There are no state-specific versions of this form since the Social Security program is uniform across the United States.

How to Fill Out SSA SSA-3373-BK

Filling out the SSA SSA-3373-BK form is a crucial step for individuals looking to provide comprehensive information regarding their capabilities and limitations due to their health condition. This form allows you to detail how your condition affects your everyday activities, which is vital for the assessment process. Completing this form accurately and thoroughly is key to ensuring your situation is fully understood by those reviewing your application. The steps below are designed to guide you through the process, making it as clear and straightforward as possible.

Begin by gathering all relevant medical documents and notes about your condition. These will provide you with the details needed when describing your limitations and capabilities.
Read through the entire form once before writing anything. This will give you a good overview of what information is required and how it should be presented.
In the section that asks for personal information, fiill in your full name, Social Security number, and any other personal details requested. Ensure all information is accurate to avoid any delays in processing.
When you come to questions about your daily activities, be honest and thorough. Describe a typical day from morning until night, including any difficulties you face and any help you receive.
For the sections that ask about your abilities, focus on how your condition affects your capacity to perform certain tasks. Include both the tasks you can do, with or without assistance, and those you cannot do.
There will be questions about medical tests, treatments, and the effectiveness of these treatments. Fill these out according to your experiences, and refer to your medical documents for accuracy.
Take your time when describing how your condition has changed over time. This information can provide valuable insight into the progression of your condition.
Before submitting the form, review it thoroughly. Check for any mistakes or omitted information. It might be helpful to have a friend or family member review it as well.
Finally, sign and date the form where indicated. If you're filling it out electronically, ensure you follow the instructions for a digital signature.
Submit the completed form following the instructions provided by the Social Security Administration. This may include mailing it or submitting it online, depending on your options.

After submitting the SSA SSA-3373-BK form, you have taken a significant step towards completing your application. It is now the responsibility of the Social Security Administration to review your submitted information. You may be contacted for additional information or to clarify the details you provided. Remember, this form is an opportunity to communicate directly about the impact of your condition on your life. Accurate and detailed information will support your application and help those assessing it to understand your needs fully.

More About SSA SSA-3373-BK

What is the SSA SSA-3373-BK form?

The SSA SSA-3373-BK, also known as the Function Report - Adult, is a document used by the Social Security Administration (SSA) to gather detailed information about how someone's medical condition affects their daily activities and ability to work. It plays a critical role in determining eligibility for disability benefits.
Who needs to fill out this form?

Individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) due to a disability may be asked to complete the SSA-3373-BK form. This requirement also applies to those currently receiving benefits, if a review of their condition is needed.
How can one obtain the SSA-3373-BK form?

This form can be downloaded from the SSA's official website. Alternatively, it can be obtained by visiting a local SSA office, or one can request to have the form mailed to them by calling the SSA's toll-free number.
What information is necessary to complete the form?

Filling out the SSA-3373-BK form requires detailed information about daily activities, including but not limited to personal care, meal preparation, chores, shopping, social activities, and information on how the applicant's condition affects their ability to work. Accurate, honest details provide the SSA with a clear understanding of the disability's impact.
Are there tips for filling out the SSA-3373-BK form effectively?
- Provide thorough and detailed responses; avoid one-word answers.
- Explain how your condition affects your daily life and ability to perform work-related tasks.
- Include specific examples when possible to illustrate the impact of your condition.
- Review your responses to ensure accuracy and completeness.
- Consider consulting with a legal representative specializing in disability law for guidance.
What happens after submitting the form?

After submission, the SSA reviews the information provided in conjunction with medical evidence to make a decision on your claim. This process can take several months. The SSA may also contact you for further information or clarification. If your claim is denied, there are options available to appeal the decision.

Common mistakes

When delving into the maze of paperwork required by the Social Security Administration (SSA), specifically the SSA-3373-BK form, a well-intentioned applicant can easily falter. This form, designed to elucidate one's disability and its impact on daily functioning, is pivotal in determining eligibility for benefits. Yet, amidst its cruciality, certain missteps are commonly made, often inadvertently, that can impede the application process. Below, we spotlight five of these pitfalls:

Offering Incomplete Responses: Many applicants, perhaps in their eagerness to submit the form or due to oversight, leave sections incomplete. Each question on the SSA-3373-BK form aims to gather comprehensive information about the applicant's condition and how it affects their life. Neglecting to fully address a question can lead to an incomplete picture of one's disability, potentially affecting the outcome of the application.
Providing Vague Descriptions: The quest for brevity can be a double-edged sword. While concise responses are appreciated, overly vague descriptions of one’s daily activities, limitations, or symptoms can be detrimental. The SSA requires specifics to understand the extent of the disability and its tangible impact on routine tasks. Vagueness can result in a lack of crucial information, making it difficult for evaluators to assess the full scope of the disability.
Omitting the Impact of the Disability on Daily Activities: It's critical to convey not just the symptoms of the disability, but also how it hampers daily functions. Applicants sometimes focus too narrowly on medical details or symptoms, omitting how these issues affect their capacity to engage in regular daily activities. Highlighting the practical effects of the disability on day-to-day life is essential for a thorough evaluation.
Excluding Information on Variations in Functioning: The nature of many disabilities is that they fluctuate over time. On certain days, an individual might function relatively well, while on other days, they might find basic tasks nearly impossible. Failure to report these variations can lead to an inaccurate assessment of one’s condition. Providing a broad understanding of the good days versus the bad days can offer a more comprehensive view of the disability's impact.
Incorrect Use of Medical Terms or Jargon: While it might seem advantageous to incorporate medical terminology, inaccurately used or misunderstood terms can more often confuse than clarify. Applicants aren't expected to be medical experts. Descriptions of symptoms, limitations, and daily challenges should be in layman’s terms to ensure clarity and prevent misunderstandings.

Avoiding these pitfalls is more than about perfecting paperwork; it's about ensuring applicants have the best possible chance at securing the support they need. Being thorough, clear, and detailed in each response not only aids the SSA in understanding your situation but also ushers you closer to the vital benefits designed to assist you. Therefore, take your time, review your answers, and consider the broader narrative of your daily experiences when completing the SSA-3373-BK form.

Documents used along the form

Applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can be an intricate process, requiring thorough documentation to prove eligibility and need. Understanding the various forms and documents that often accompany the SSA-3373-BK form—Function Report - Adult—can help applicants better prepare for the application process. While SSA-3373-BK provides detailed information about how an individual's impairments affect their daily activities, there are additional forms and documents that play critical roles in supporting an application.

SSA-3368-BK: Disability Report - Adult - This form is where an applicant starts their disability claim, providing basic information about their medical condition and how it affects their ability to work.
SSA-3369-BK: Work History Report - It details the applicant's work history for the past 15 years, helping SSA determine if the applicant can perform any of their past work despite their disability.
SSA-827: Authorization to Disclose Information to the Social Security Administration - This form grants SSA permission to request medical records on behalf of the applicant, which is crucial for supporting the disability claim.
SSA-3820-BK: Disability Report - Child - For those applying on behalf of a child, this report gathers information similar to the SSA-3368-BK but tailored to children's conditions.
SSA-8000-BK: Application for Supplemental Security Income - This form is specific to the SSI program, collecting information on income, resources, and living arrangements to determine financial eligibility.
SSA-561: Request for Reconsideration - If an initial application is denied, this form is used to request a review of the decision by SSA.
SSA-3441: Disability Report - Appeal - When appealing a decision, this report allows the applicant to update information about their condition and any new medical treatment, tests, or diagnoses.
SSA-789: Request for Hearing by Administrative Law Judge - If reconsideration is denied, this form is used to request a hearing in front of an Administrative Law Judge for another chance at approval.
Medical Records: Comprehensive medical records are essential, providing proof of disability through treatment notes, test results, and diagnoses from healthcare providers.
Doctor's Statements: Statements from treating physicians can significantly impact a claim, offering expert opinions on the applicant's condition and how it limits their capacities.

Navigating the SSDI or SSI application process involves compiling and submitting various key pieces of documentation, in addition to the SSA-3373-BK form. Each document serves its own purpose, from demonstrating financial eligibility to detailing medical conditions and work history. Applicants are encouraged to gather as much relevant information as possible before submitting their application to ensure a thorough and accurate representation of their situation. Understanding and collecting these documents can be a critical step in successfully navigating the disability benefits application process.

Similar forms

SSA-3368-BK (Disability Report - Adult): Like the SSA-3373-BK Function Report, the SSA-3368-BK form is used by individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Both forms gather detailed information about the applicant, but the SSA-3368-BK focuses more on medical conditions, treatment history, and work history, whereas the SSA-3373-BK concentrates on how the applicant's condition affects their daily living activities and capabilities.
SSA-3380-BK (Third Party Adult Function Report): This form parallels the SSA-3373-BK in its objective to assess the impact of an individual's disability on their daily life. However, the SSA-3380-BK is filled out by a third party who knows the applicant well, providing an external observation of the applicant’s capabilities and limitations. Both forms are instrumental in giving the Social Security Administration (SSA) a fuller picture of the applicant's condition and how it affects day-to-day functions.
SSA-3441-BK (Disability Report - Appeal): The SSA-3441-BK is used when an applicant needs to appeal a previously made decision regarding their SSDI or SSI claim. Like the SSA-3373-BK, it collects detailed information about how the applicant's disability affects them, but with a focus on any new information or changes since the initial application or last report. Both forms play crucial roles in the decision-making process for benefit eligibility and continuation.
SSA-827 (Authorization to Disclose Information to the Social Security Administration): Although the SSA-827 form is primarily an authorization form that allows the SSA to obtain medical, educational, and other records on behalf of the applicant, it shares a connection with SSA-3373-BK in the process of disability claims. The information authorized for release by SSA-827 can provide supporting evidence for the details disclosed in the SSA-3373-BK, helping to substantiate the claims made about the applicant’s daily living activities and restrictions caused by their disability.

Dos and Don'ts

The SSA-3373-BK form, also known as the Function Report - Adult, is a critical document for individuals seeking disability benefits through the Social Security Administration (SSA). To ensure accurate and effective completion of this form, there are several recommended practices to follow, as well as common pitfalls to avoid. Below are the dos and don'ts when filling out the SSA-3373-BK form:

Things You Should Do:

Provide Detailed Explanations: When describing how your condition affects your daily activities and abilities, be as detailed and specific as possible. General statements are less helpful than clear examples.
Be Honest and Consistent: Ensure that the information provided on the form mirrors what you've told your doctors and what is noted in your medical records. Accuracy and consistency are fundamental.
Consider the Bad Days: When describing your abilities, think about your more difficult days. This provides the SSA with a realistic view of your limitations.
Ask for Help if Needed: If completing the form is challenging, don't hesitate to seek assistance from a trusted friend, family member, or a professional, such as a Social Security disability attorney or advocate.

Things You Shouldn't Do:

Underestimate Your Limitations: Don't downplay the extent of your disability. If you omit the severity of your limitations, it could lead to an inaccurate assessment of your functional capacities.
Leave Sections Blank: If a particular section does not apply to you, indicate this with a "Not Applicable" or "N/A" response. Leaving sections blank might lead to unnecessary delays or questions.
Rush Through the Form: Take your time to fill out the form carefully. Rushing can lead to mistakes or omissions that might negatively affect your claim.
Ignore the Instructions: Follow all provided instructions closely. Misinterpreting questions or ignoring instructions can lead to incorrectly filled forms, impacting the outcome of your application.

Misconceptions

When individuals engage with the Social Security Administration (SSA), particularly in relation to disability benefits, they might encounter form SSA-3373-BK, also known as the Function Report. Understandably, this can lead to a great deal of confusion and misconceptions. It's paramount to approach this document with accurate information, as it significantly influences the assessment of one's eligibility for benefits. Below, we dissect some common misconceptions that often need clarification.

Filling out the form is optional. Many believe that submitting the SSA-3373-BK form is not mandatory when applying for disability benefits. This is incorrect. The form is a crucial component of the application process. It provides the SSA with a detailed account of how an individual's disability affects their daily life and ability to work. Neglecting to fill out this form can lead to a delay in the decision or even a denial of benefits.
The more medical terms used, the better. While it might seem logical to use medical terminology to describe one's condition, this approach can sometimes be counterproductive. The primary goal of the SSA-3373-BK form is to understand the practical implications of your disability on daily activities. It's often more helpful to describe how your condition affects your day-to-day life in plain language rather than focusing solely on medical terms.
It's unnecessary to mention routine daily activities. Some applicants assume that everyday activities irrelevant to their condition don't need to be included. However, the SSA uses information about daily activities to gauge the severity of a disability and how it interferes with ordinary life. Details about personal care, household chores, and social activities provide a fuller picture of one's capabilities and limitations.
Only physical disabilities need to be detailed. This is a significant misunderstanding. The SSA recognizes both physical and mental impairments that can restrict work activity. Describing how a mental health condition affects concentration, memory, social interaction, and task completion is equally important as detailing physical limitations.
Negative side effects of medication are irrelevant. On the contrary, the SSA considers the side effects of medications as they can impact an individual's ability to function. If medication causes drowsiness, dizziness, or other impairments, this information can influence the assessment of a disability's severity and the individual's functional capacity.
One-time completion is sufficient. Many applicants fill out the form once and think it's done for good. However, disability claims can extend over months or even years, and conditions can change. Updating the SSA with current information by submitting a new or revised SSA-3373-BK form can be crucial to maintaining an accurate profile of your condition and how it affects your life.

Ultimately, the SSA-3373-BK form is a vital communication tool between applicants and the Social Security Administration. By debunking these misconceptions, individuals are better equipped to provide accurate and comprehensive information, thereby improving their chances of a favorable outcome. Understanding the form's significance and approaching it with diligence and honesty can significantly impact the disability benefits process.

Key takeaways

Completing the SSA SSA-3373-BK form accurately is crucial for those seeking disability benefits through the Social Security Administration. It provides a comprehensive record of how an individual's disability affects their daily life and capability to work.
Applicants should provide detailed descriptions of their daily activities, ensuring they highlight the limitations caused by their disability. Being specific about the ways in which their ability to perform everyday tasks is impaired can significantly influence the outcome of their claim.
The form requires information on medical treatments received, including medications, therapies, hospital stays, and surgeries. Listing all healthcare providers with contact details is essential for verifying the medical evidence supporting the disability claim.
It's recommended that applicants include any modifications or assistive devices they use in their daily routine. This could include anything from special utensils for eating to mobility aids. Such details offer a clearer picture of the disability's impact.
When filling out the form, maintaining honesty and transparency is key. Exaggerating or minimizing the effects of one's disability can lead to complications in processing the claim. Accurate representation ensures a fair evaluation by the SSA.
Before submitting the SSA-3373-BK form, applicants should review their answers, checking for completeness and accuracy. It's also advisable to keep a copy of the completed form for personal records. Such precautions help in case the form needs to be revisited during the application process.

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