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Free SSA SSA-3373-BK PDF Form

The SSA SSA-3373-BK form, commonly referred to as the Adult Disability Report, is a crucial document used in the United States to provide detailed information about an individual's medical condition and how it affects their ability to work. This form plays an essential role in the Social Security Administration's process of determining eligibility for disability benefits. For those navigating the complexities of applying for disability benefits, accurately completing this form is a vital step toward securing necessary support.

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Content Overview

Applying for Social Security disability benefits involves providing the Social Security Administration (SSA) with detailed information about one's medical condition and how it affects their ability to work. One of the key pieces in this process is the SSA-3373-BK form, also known as the Adult Disability Report. This form plays a vital role, as it is designed to capture the applicant's complete medical history, employment background, and the ways in which their disability impacts their daily living and employment capabilities. Completing it accurately is crucial for applicants, as the information provided will be closely examined by the SSA to make a determination on their disability claim. The form requests detailed descriptions of treatments, medications, and any other measures the applicant has taken to manage their condition, in addition to documentation of their work history. For many, this form can be daunting due to its comprehensive nature, but it is an essential step in seeking the financial support needed to manage their health conditions.

Example - SSA SSA-3373-BK Form

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

Click for SSA SSA-3373-BK PDF

Form Data

Fact Name	Fact Detail
Form Purpose	The SSA-3373-BK form is used by the Social Security Administration to collect information about an individual's medical condition and how it affects their ability to work.
Form Name	The official name of the form is "Function Report - Adult."
Who Must Complete	This form is typically filled out by individuals who are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) due to a disability.
Information Collected	The form gathers details about daily activities, abilities, medical treatment, and the effects of symptoms on work performance.
Submission Method	The completed form can be submitted to the Social Security Administration through mail or in person at a local SSA office.
Frequency of Submission	Applicants may be required to fill out this form during the initial application process and possibly for periodic updates at the discretion of the SSA.
Supporting Documentation	While filling out the form, applicants may need to reference medical records, employment history, and any educational records that show how the disability affects their daily functions.
Governing Laws	The SSA operates under federal law, making the SSA-3373-BK form consistent across the United States without state-specific variations.
Penalties for False Statements	Making false statements on this form can result in penalties, including fines or imprisonment, as well as the denial of benefits.

How to Fill Out SSA SSA-3373-BK

Once you've decided to proceed with your claim, the next step involves completing the SSA-3373-BK form. This document is essential for providing a comprehensive overview of your medical condition and how it affects your daily life. The information you provide will help assess your eligibility for benefits. It's important to be thorough and clear when filling out the form to ensure your circumstances are accurately represented. Below are the steps that will guide you through the process of filling out the form.

Gather all required information, including medical records, lists of medications, and details of your treating physicians.
Begin by entering your personal information, such as your name, Social Security number, and contact information, in the designated sections.
Proceed to the sections that ask about your medical conditions. List all conditions that apply, including the dates of diagnosis.
Fill in details about your treatment history. This includes the types of treatments you've received, the names of the medical providers, and the dates of treatment.
Next, describe how your medical condition affects your day-to-day activities. Be specific about any limitations or changes in your routine.
For the sections regarding work history, provide information about your past employment and how your medical condition has impacted your ability to work.
Review the form to ensure all information is accurate and complete. Pay close attention to the instructions for each section to ensure you're providing the required details.
Sign and date the form. If you're sending the form electronically, make sure to follow the instructions for electronic signatures.
Submit the form to the Social Security Administration, either by mail or online, following the instructions provided with the form.

After submitting the SSA-3373-BK form, your application will be reviewed. The Social Security Administration may contact you if additional information is needed. This process can take some time, so it's important to respond promptly to any requests from the SSA. Patience is key during this period, as the review of your claim is critical to determining your eligibility for benefits.

FAQ

What is the SSA-3373-BK form used for?

The SSA-3373-BK, also known as the Function Report - Adult, is a form used by the Social Security Administration (SSA). It collects detailed information about how an individual's health condition affects their daily activities and ability to work. The SSA uses this form to determine eligibility for disability benefits.

How do I fill out the SSA-3373-BK form?

To complete the SSA-3373-BK form, you need to provide comprehensive information about your daily activities, medical conditions, treatments, and any limitations you experience. It’s important to be thorough and honest in your responses. Include examples of how your condition affects tasks like personal care, household chores, social activities, and if applicable, why you cannot work. If there isn't enough space on the form for your answers, you can add additional sheets of paper.

Can I submit the SSA-3373-BK form online?

Yes, you have the option to submit the SSA-3373-BK form online through the Social Security Administration's website. To do so, you must have a personal my Social Security account. If you do not have one, you can create an account on the SSA website. Submitting your form online can be faster and more convenient than mailing a paper copy.

What tips should I consider when completing the SSA-3373-BK form?

When filling out the SSA-3373-BK form, remember to detail how your condition affects your daily life rather than just listing your medical conditions. Be specific about your limitations and the assistance you require. It’s also helpful to discuss your form with your healthcare provider, as they can provide insight into your condition and its impact on your daily functions, which you can include in your report. Lastly, double-check your responses for accuracy before submitting the form.

Common mistakes

Filling out governmental forms can be a complicated process, and errors may lead to delays or problems in the processing of applications. When it comes to the Social Security Administration's SSA-3373-BK form, also known as the Function Report - Adult, individuals often make several common mistakes. This form is an important part of determining eligibility for disability benefits, as it details an applicant's daily activities and the impact of their disability on their life. Here are seven mistakes to avoid:

Not Providing Detailed Descriptions: Many applicants provide short, vague answers instead of describing how their condition affects their daily activities in detail. It's important to offer clear examples that show the extent of your limitations.
Overlooking the Importance of Routine Tasks: Applicants sometimes fail to mention how their condition affects their ability to perform routine tasks, such as personal care, cooking, cleaning, or shopping. These details are crucial in assessing how a disability impacts daily living.
Forgetting to Include Information on Social Activities: The form also inquires about the applicant's ability to engage in social activities. Leaving this section blank or not providing enough information can result in an incomplete picture of the impact of the disability.
Not Being Consistent: Inconsistencies in the information provided on the SSA-3373-BK and other forms, such as the work history report, can raise questions about the accuracy of the information provided. It is critical to maintain consistency across all documents.
Ignoring Mental Health Impacts: When a physical disability is the primary reason for applying, applicants sometimes neglect to mention how their condition affects their mental health. Describing both physical and mental health impacts can provide a fuller understanding of the disability's effects.
Not Highlighting Changes in Abilities: It's important to indicate any changes in your abilities over time. A disability can be progressive, and demonstrating how your condition has worsened can be an important factor in your application.
Submitting the Form Without Reviewing: A common mistake is rushing to submit the form without thoroughly reviewing it for accuracy and completeness. Taking the time to double-check your responses can prevent errors and potential delays.

To avoid these mistakes, it's beneficial to approach the SSA-3373-BK form with careful attention to detail. Providing comprehensive and accurate responses about how your disability affects your daily life is essential in supporting your application for benefits. Remember, the goal is to give the Social Security Administration a clear and complete picture of your situation.

Documents used along the form

The Social Security Administration (SSA) uses a variety of forms to evaluate eligibility and process applications for benefits, including disability claims. Among these, the SSA SSA-3373-BK form stands out as a key document. It's dedicated to collecting detailed information regarding an individual's medical conditions and how these impairments affect their ability to work. When submitting this form, it's often necessary to include additional documents to provide a comprehensive view of one’s situation. Here is a list of other forms and documents frequently used alongside SSA-3373-BK.

SSA-3368-BK: The Adult Disability Report is an essential form where applicants detail their medical conditions, treatment history, and how their disabilities affect their daily activities and work capabilities. This form pairs with SSA-3373-BK to give a clear picture of the applicant's health status.
SSA-3369-BK: Work History Report. Applicants use this form to provide a detailed account of their work history over the past 15 years. This information helps the SSA determine if the individual can perform any of their past work despite their disability.
SSA-827-BK: Authorization to Disclose Information to the Social Security Administration. This critical form allows the SSA to request and obtain medical records from healthcare providers. It's key to verifying the medical information presented in SSA-3373-BK and other related forms.
SSA-3820-BK: Disability Report - Child. For those applying for disability benefits for a child under 18, this form collects similar information to the adult report but is tailored to the needs and activities of children.
Medical Records: Though not a form provided by the SSA, applicants must often submit relevant medical records alongside these forms. These documents include diagnosis details, treatment plans, and information on the progression of medical conditions, serving as evidence to support the claim.

Together, these forms and documents paint a full picture of an individual's health and work situation, critical for the SSA's decision-making process. Applicants should ensure they provide thorough and accurate information on each form and include all necessary additional documents, as the SSA heavily relies on this compilation of paperwork to assess eligibility for disability benefits. Understanding the role of each document can significantly streamline the application process.

Similar forms

SSA-3368-BK (Disability Report - Adult): Much like the SSA-3373-BK, this form is used in the process of applying for Social Security disability benefits. While the SSA-3373-BK focuses on collecting information on daily activities and abilities, the SSA-3368-BK gathers comprehensive data on the applicant’s medical condition, treatment history, and work activity, making both forms critical for evaluating disability claims.
SSA-3441-BK (Disability Report - Appeal): This form is similar to the SSA-3373-BK because it’s used when an individual wishes to appeal a decision made about their disability benefits. The SSA-3441-BK is designed to update the Social Security Administration on any changes in the individual’s condition or treatment, information that might also be detailed in the SSA-3373-BK when first applying for benefits.
SSA-3820-BK (Disability Report - Child): Parallel to the SSA-3373-BK, this document is filled out as part of the process to apply for Supplemental Security Income (SSI) for children under the age of 18 who have disabilities. It gathers detailed information about the child's medical condition, schooling, and how the disability affects their life, similar to the way the SSA-3373-BK seeks to understand the daily limitations of an adult applicant.
SSA-8000-BK (Application for Supplemental Security Income): This form is akin to the SSA-3373-BK in terms of its role in the SSI application process. While the SSA-3373-BK focuses on the functional aspects of a person’s disability, the SSA-8000-BK collects financial and household information to determine eligibility for SSI benefits, demonstrating how different forms complement each other to provide a full picture of the applicant’s situation.
SSA-820-BK (Work Activity Report - Employee): This document, though more specific in scope, is related to SSA-3373-BK in that it helps assess the capability of a person with disabilities to perform work-related activities. While SSA-3373-BK might document the general daily activities and skills of an individual, SSA-820-BK focuses on the ability to engage in employment, informing the SSA about the impact of the disability on work capacity.
SSA-783 (Statement Regarding Marriage): While primarily concerning marital status and its influence on benefit entitlements, this form intersects with information that might be present in SSA-3373-BK. For example, if marital status affects the care or assistance an individual receives for their disability, this can be an important consideration in both forms.
SSA-827 (Authorization to Disclose Information to the Social Security Administration): This form doesn’t collect personal information directly like the SSA-3373-BK but facilitates the process by authorizing the release of medical records and other pertinent information. Both forms are integral parts of compiling a claimant’s profile and determining their eligibility for disability benefits.
SSA-1696 (Appointment of Representative): Sharing a complementary role with the SSA-3373-BK, this document is used to designate a representative for handling communications with the SSA. The person appointed might assist in gathering and providing detailed accounts of daily activities and limitations of the claimant, as described in the SSA-3373-BK, contributing to the comprehensive assessment of the disability claim.

Dos and Don'ts

When filling out the SSA SSA-3373-BK form, known as the Function Report - Adult, it's important to approach the task with careful attention to detail and complete honesty. The form assesses your daily activities and how your condition affects them, playing a crucial role in determining your eligibility for Social Security benefits. Here are eight do's and don'ts to guide you through the process:

Do:

Read the instructions carefully before you start filling out the form to ensure you understand what information is required.
Provide detailed explanations of how your condition affects your daily activities, not just yes or no answers.
Be honest and accurate about your limitations and abilities. Exaggerating or downplaying your condition can harm your case.
Use extra sheets of paper if you run out of space on the form. Make sure to include your name, Social Security number, and the question you're answering on each additional page.

Don't:

Leave any sections blank. If a question does not apply, write "not applicable" or "N/A" to indicate that you didn't overlook the question.
Forget to describe the variability of your condition, if applicable. Your abilities may change from day to day, and it's important to describe these fluctuations.
Submit the form without reviewing it for errors or omissions. Double-check your answers and ensure that you've completed each section as thoroughly as possible.
Overlook the importance of being thorough. While you should avoid unnecessary information, it's crucial to provide enough detail to give a clear picture of your daily life and limitations.

Misconceptions

When dealing with the Social Security Administration (SSA) and the Form SSA-3373-BK, also known as the Function Report - Adult, people often harbor misconceptions. Understanding these inaccuracies is crucial for anyone navigating through the process of applying for disability benefits. Below are eight common misconceptions about the SSA-3373-BK form and explanations to help clarify each point.

Filling it out is straightforward and requires no preparation. This form asks detailed questions about how your condition affects your daily activities and ability to work. Before completing it, gathering information and reflecting on the specifics of your condition and its impact on your life is advisable. This preparation helps ensure accuracy and thoroughness.
The form is secondary to medical records. While medical records are undoubtedly crucial, the SSA-3373-BK form provides the SSA with context that medical records might not fully capture. It offers a narrative of your daily life and limitations, which is essential for evaluating your claim.
Only physical health problems matter on the form. The SSA recognizes both physical and mental impairments. Thus, it's important to detail how your mental health condition, if you have one, affects your daily functioning and ability to work in addition to any physical health issues.
The more limitations you list, the stronger your case. While it might seem logical to list as many limitations as possible, the SSA values accuracy and consistency. Fabricating or exaggerating limitations can harm your credibility. It's best to provide an honest and precise account of your limitations.
Activities of daily living are irrelevant to your claim. On the contrary, how your condition affects your ability to perform daily activities provides critical insight into your level of impairment. These activities include self-care, cooking, cleaning, shopping, and using public transportation, to name a few.
Assistance from friends or family should not be mentioned. The support you receive plays a key role in illustrating your condition's reality. If assistance is necessary for you to perform basic functions or activities, it's important to include this information on the form.
Your description of a typical day must reflect your worst day. Many applicants believe they need to describe their most challenging day. However, it's more helpful to provide a balanced view that reflects a range of experiences, from your best days to your worst days, to give a full picture of your condition over time.
The impact of your condition on your ability to work is self-evident. It might seem that the limitations caused by your condition are obvious, but the SSA requires detailed explanations. Describing how your symptoms affect specific job functions and tasks is vital for the SSA to understand the full extent of your disability.

In conclusion, completing the SSA-3373-BK form with accuracy, details, and honesty while avoiding these misconceptions can significantly impact the success of a disability claim. Remember, this form is a vital piece of your application, offering a comprehensive view of how your disability affects your life and confirming the information presented in your medical records.

Key takeaways

When dealing with the Social Security Administration (SSA), understanding how to accurately fill out and use the SSA-3373-BK form, also known as the Function Report - Adult, is crucial. This form is used by the SSA to evaluate your physical and mental capabilities and how they affect your ability to perform work-related activities. Here are eight key takeaways to help navigate through the process:

Complete the form thoroughly: Provide detailed and specific answers to every question on the form. This is your opportunity to explain how your condition affects your daily life and ability to work. Leaving sections incomplete can result in a delay or a denial of your claim.
Be honest and consistent: Honesty is paramount when filling out the SSA-3373-BK. Exaggerating or minimizing your limitations can harm your case. Ensure your responses are consistent with other information you've provided to the SSA or your healthcare providers.
Focus on limitations: While it's important to describe your daily activities, the primary goal is to highlight the limitations your condition imposes. Be clear about the tasks you cannot perform or can only perform with difficulty.
Use additional pages if necessary: If the space provided on the form is insufficient to explain your situation, attach additional sheets of paper. Make sure each page is clearly marked with your name and Social Security number.
Provide examples: Whenever possible, include specific examples that illustrate your limitations, such as difficulty standing for more than a few minutes or trouble concentrating for extended periods.
Don't overlook mental and emotional health: The SSA-3373-BK form also covers mental and emotional health. Be sure to describe any cognitive, emotional, or mental health issues related to your ability to work.
Review your form before submitting: Go over your completed form to ensure accuracy and completeness. It's helpful to have a trusted friend or family member review it as well.
Keep a copy for your records: After submitting the form to the SSA, keep a copy for your own records. This will be useful for any future correspondence or appeals with the SSA.

Filling out the SSA-3373-BK form accurately and comprehensively can significantly impact the outcome of your disability claim. It's a critical step in demonstrating how your disability affects your everyday life and your ability to work. Taking your time to carefully address each section will help the SSA understand your situation better and make an informed decision regarding your claim.

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