We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Form Ssa 3373 Bk 12 2009 Ef 12 2009

Get Form Ssa 3373 Bk 12 2009 Ef 12 2009

Sh or verify a person's eligibility for Federally-funded or administered benefit programs and for repayment of payments or delinquent debts under these programs. Additional information regarding this form, routine uses of information, and our programs and systems, is available on-line at www.socialsecurity.gov or at any local Social Security office. Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. 3507, as amended by section 2 of the Paperwor.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Form SSA 3373 BK 12 2009 EF 12 2009 online

Completing the Form SSA 3373 BK 12 2009 EF 12 2009 online is a vital step for people seeking to report how their conditions affect their daily activities. This guide provides clear and supportive instructions to ensure you fill out the form accurately and thoroughly.

Follow the steps to complete the form successfully.

  1. Click 'Get Form' button to obtain the form and open it in the editor.
  2. Begin with Section A, which seeks general information. Fill in your name, social security number, and contact details as requested.
  3. In Section B, provide details about your illnesses, injuries, or conditions and how they impact your ability to work. Be honest and thorough in your responses.
  4. Proceed to Section C, which focuses on daily activities. Describe your routine from morning to night. Include information about personal care, meals, household tasks, and shopping habits.
  5. In Section D, assess your abilities. Indicate which areas your conditions affect, such as lifting, walking, or memory. Explain how these limitations impact your daily life.
  6. Use the 'REMARKS' section on Page 8 for any important additional information you wish to include.
  7. Review the entire form for completeness and accuracy before submitting it. Ensure you have filled in all required fields and provided clear explanations where necessary.
  8. Once completed, save your changes. You can download, print, or share the form as needed.

Complete your documents online today to ensure a smooth submission process.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Function Report- Adult - Social Security
the form, you can get it by calling Social Security at 1-800-772-1213. HOW TO COMPLETE...
Learn more
[MOBI] Ssa 3373 Bk Fillable
FormSSA-3373-BK(12-2009) ef(04-2010) Destroyprioreditions … Function Report - Adult...
Learn more
20100804x AZ 6801 Appraisal Youngtown AZ.sflb
Residents suffering from Alzheimer's or some other form of dementia typify the higher...
Learn more

Related links form

Written Document Analysis Worksheet - UMBC Performance Assessment For School Leaders (PASL) Walk-through Observation Form. Performance Ipo Application Form City Of La Bonded Sewer Contractor List

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

How to Answer Disability Questionnaires Write clearly and legibly. Avoid erasures as much as possible. ... Do not leave any section of the form blank (unless otherwise specified). ... Give consistent answers. ... Answer the questions truthfully. ... Follow the instructions on the form.

Typically, the process of applying for disability begins with you filing an initial claim for benefits and submitting a Form SSA-827 to release your medical records. If those medical records don't provide enough information to make a decision, then the SSA will typically ask you to fill out Form SSA-3373-BK.

The SSA has an optional form called the Function Report that DDS uses when they are in need of additional information about how an applicant is able to function in everyday life.

Social Security Form SSA-3373-BK is a lengthy form that you fill out as a part of the process of applying for Social Security Disability benefits. It also goes by the Adult Disability Report or the Adult Function Report.

Activities of daily living include any activity you engage in on a daily basis such as showering, brushing your teeth, house cleaning, shopping, etc. The SSA needs to know if your condition causes pain or difficultly when performing any daily activity.

Question 5 on the SSD Function Report asks, “How do your illnesses, injuries, or conditions limit your ability to work?” Don't just list symptoms of your conditions here. Specifically describe what tasks you couldn't do at your former jobs that caused you to stop working or be terminated.

When you apply for social security disability you will be required to complete a Function Report (Form SSA-3373-BK). The purpose of the Function Report is to provide the Social Security Administration with information about how your disability affects your ability to perform everyday functions.

Do not leave any answers blank. If you have no answer for a question, you should answer “none” or a similar response. This form is designed to use plain language so you can understand it yourself. You should not need special medical knowledge or professional skills to complete it.

A Function Report is a multi-page questionnaire about an applicant's activities and how their disabilities impact their daily lives.

9 tips for filling out the function report Keep your answers consistent. ... Start with question 20. ... Answer questions directly. ... Talk about your average or worst days. ... Be honest and don't exaggerate. ... Send additional information as quickly as possible. ... Talk about all conditions that keep you from working.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Form Ssa 3373 Bk 12 2009 Ef 12 2009
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232