
Ate how often the individual can perform the following activites: Right Hand ACTIVITY Never Occasionally (up to 1/3) Left Hand Frequently (1/3 to 2/3) Continuously (over 2/3) Never Occasionally (up to 1/3) Frequently (1/3 to 2/3) Continuously (over 2/3) REACHING (Overhead) REACHING (All Other) HANDLING FINGERING FEELING PUSH/PULL Which is the individual's dominant hand? Right Hand Left Hand Identify the particular medical or clinical findings (i.e., physical exam findings, x-ray fi.
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How to fill out the SSA HA-1151-BK online
The SSA HA-1151-BK is a crucial form used to evaluate an individual's ability to perform work-related activities. Filling out this form accurately is vital for the determination of eligibility for Social Security benefits. This guide provides step-by-step instructions to help users complete the form online with ease.
Follow the steps to fill out the SSA HA-1151-BK online.
- Press the ‘Get Form’ button to retrieve the SSA HA-1151-BK form and open it in your online editor.
- Begin with the individual's social security number and name in the designated fields to personalize the document.
- In section 'I. Lifting/Carrying,' indicate the individual's capabilities regarding lifting and carrying by checking the appropriate boxes for each weight category.
- Provide medical or clinical findings related to the lifting and carrying limitations, ensuring that specific examples underpin your assessment.
- In section 'II. Sitting/Standing/Walking,' fill in how many hours or minutes the individual can sit, stand, and walk at a time without interruption.
- Ensure to note any additional activities the individual engages in during the remaining hours of an 8-hour workday.
- Indicate whether the individual uses a cane to ambulate and provide details on their ambulation capabilities.
- In section 'III. Use of Hands,' indicate how frequently the individual can perform reaching, handling, fingering, and other specified activities with both hands.
- Confirm the dominant hand of the individual and provide supporting medical findings relevant to hand use limitations.
- Next, in section 'IV. Use of Feet,' record how often the individual can operate foot controls using both right and left feet.
- Proceed to 'V. Postural Activities' and select how often the individual can perform climbing, balancing, and other postural activities.
- In section 'VI. Hearing or Vision Impairments,' indicate if the individual has any impairments and answer related questions.
- Fill out section 'VII. Environmental Limitations' with a check in the appropriate boxes concerning exposure to various environmental conditions.
- Complete section 'VIII' by checking whether the individual can perform basic activities, or identify any other work-related activities affected in section 'IX'.
- Record the duration of limitations in section 'X' and confirm whether they will last for 12 consecutive months.
- Finally, ensure the form is signed and dated, and print the name, title, and medical specialty of the individual completing the form.
- Save changes to the document, and download or print it for submission or sharing.
Start completing your SSA HA-1151-BK online today!
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