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WORK HISTORY REPORT- Form SSA-3369-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this form, complete as much of it as you can. Then call.

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How to fill out the Function Report Adult Form SSA 3369 BK online

Filling out the Function Report Adult Form SSA 3369 BK online can seem daunting, but understanding its components can simplify the process. This guide provides step-by-step instructions to help make your form completion experience clear and manageable.

Follow the steps to complete the Function Report Adult Form SSA 3369 BK online.

  1. Press the ‘Get Form’ button to access the form and open it in the editor.
  2. Begin with Section 1, where you will enter the information about the person applying for disability benefits. Fill out their name, social security number, and daytime telephone number as indicated.
  3. Proceed to Section 2, where you will provide details about your work history. List all jobs held in the 15 years prior to becoming unable to work due to illnesses, injuries, or conditions. Include job titles, type of business, and exact dates worked.
  4. For each job listed, provide detailed information that includes rate of pay, hours worked per day, and an extensive description of duties. Use the separate pages for additional jobs as necessary.
  5. Answer specific questions for each job, such as whether you used machines or technical skills. Indicate physical activities performed daily and the weights lifted regularly, marking the appropriate boxes.
  6. If more information is needed, utilize the 'Remarks' section on Page 8. Indicate the question number you are addressing to clarify your responses.
  7. Finally, ensure you complete the bottom of Page 8, including your name (if filling out for someone else), the date, and contact address, before submitting the completed form.
  8. Once all sections are complete, save changes, and utilize options to download, print, or share the form as needed.

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Another smart thing to include in your ADL form is if you need help doing daily chores. For example, if someone in your family drives you to the store or needs to shop for you because you cannot lift, then write that down. If a friend does your laundry because you can't carry it, then put that on the form.

You should describe specific examples of how you're limited—physically, mentally, or both—in your daily activities. Also, be sure to mention your difficulties with daily activities to your doctor, so that they become part of your medical record.

List each job, even if you performed them for the same business or organization. Be specific with dates. The month, date, and year must be entered for when each job title began and ended. Be sure to provide the most detailed and specific information you possibly can for each job title you enter on the form.

How to Fill Out an Adult Function Report for Disability (7 Tips) Answer Every Question and Be Honest! ... Answer Only the Questions Being Asked. ... Give as Much Detail as You Can. ... Be Consistent (Some Questions Overlap) ... Be Specific on Question 5 of the Function Report. ... Don't Limit Your Answers to the Space on the Form.

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.

The Disability Determination Services (DDS) uses the information on the 3368 to develop medical and other evidence that can be used to establish the correct onset date. The 3368 is also used to assess the alleged disability in conjunction with nonmedical factors, such as education and work history.

The Function Report is a 10-page form that asks about your daily activities and how your health conditions affect your ability to work or go through life. It's also one of the main forms you'll fill out when you apply for Social Security disability benefits. It's also one of the most important forms in the application.

Function Report Question #10: What were you able to do before your illnesses, injuries, or conditions that you can't do now? This is a very important question. Spend time here explaining things you enjoy but can no longer do because of your disability. Be specific as to why you can no longer do them.

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