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
  • Independent Agency Forms
  • Independent Agency SSA Forms
  • Ssa-3380-bk 2020

Get Ssa-3380-bk 2020-2025

How do this person s illnesses injuries or conditions limit his/her ability to work Form SSA-3380-BK 12-2009 ef 01-2013 Use 12-2009 Edition Until Supply Exhausted Page 1 9. FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP HOW TO COMPLETE THIS FORM The information that you give on this form will be used to make a decision on the disabled person s claim. You can help by completing as much of the form as you can. When a question refers to the disabled person it refers to the person who is applying for or receiving disability benefits. If you need more space to answer any questions use the REMARKS section on Page 8 and show the number of the question being answered. REMEMBER TO GIVE US THE NAME AND ADDRESS OF THE PERSON COMPLETING THIS FORM ON PAGE 8 Function Report - Adult - Third Party Form SSA-3380-BK If you need help with this form complete as much of it as you can and call the phone number provid....

This website is not affiliated with any governmental entity

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 SSA-3380-BK online

The SSA-3380-BK is a vital form used by the Social Security Administration to assess an individual's disability claims. Completing this form accurately is essential for making informed decisions regarding benefits. This guide will provide clear instructions on how to fill out the form online effectively.

Follow the steps to complete the SSA-3380-BK form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
  2. Begin with Section A - General Information. Fill in the required details about the disabled person, including their name and relationship to you. Make sure to include your own name and daytime phone number.
  3. Proceed to Section B - Information About Illnesses, Injuries, or Conditions. Describe the limitations the disabled person experiences regarding their ability to work.
  4. Move on to Section C - Information About Daily Activities. Provide thorough descriptions of the disabled person's daily routines, including their capacity for personal care, meal preparation, household chores, and social interactions.
  5. In Section D - Information About Abilities, check any applicable conditions that affect the disabled person's functionality and detail how those limitations manifest.
  6. Complete Section E - Remarks. Use this section to add any additional information that may support the disabled person's claim, ensuring clarity and relevance.
  7. After filling out all sections, review the form for accuracy and completeness. Save your changes and choose to download, print, or share the completed form as necessary.

Begin completing the SSA-3380-BK online to ensure accurate information is submitted for the disability claim.

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
FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK. READ ALL OF THIS INFORMATION...
Learn more
Appendix C: Selected Forms | Informing Social...
Adult Third Party Function Report Form (Form SSA-3380-BK), 196. U.S. OFFICE OF PERSONNEL...
Learn more

Related links form

Maintenance Control Officer AET Learner Information Form - AgriSeta Tuition Grant Declaration Form Bsf Application

Questions & Answers

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

Contact support

Contact the Social Security Administration to request a copy of your work history and dates. You will need Form 7050, which is available online. Check the Detailed Earnings Information box on the form.

You can view your personal Social Security Statement online by creating a my Social Security account with us. Your online Social Security Statement displays uncertified yearly earnings free of charge and does not show any employer information. To sign in or create an account, go to www.socialsecurity.gov/myaccount.

There are several different ways to find your work history information, including: ... Submitting a Request for Social Security Earnings Information Form (requires fee) with the Social Security Administration. Contacting previous employers' human resources departments.

1:02 7:51 Suggested clip How to Fill Out the Work History Report Form | Cleveland, Ohio ...YouTubeStart of suggested clipEnd of suggested clip How to Fill Out the Work History Report Form | Cleveland, Ohio ...

0:08 4:15 Suggested clip How do I fill out the Work History Report (Form SSA-3369)? - YouTubeYouTubeStart of suggested clipEnd of suggested clip How do I fill out the Work History Report (Form SSA-3369)? - YouTube

0:00 5:07 Suggested clip How do I fill out the Adult Function Report (Form SSA - 3373 - BK ...YouTubeStart of suggested clipEnd of suggested clip How do I fill out the Adult Function Report (Form SSA - 3373 - BK ...

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. ... 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.

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.

0:00 5:07 Suggested clip How do I fill out the Adult Function Report (Form SSA - 3373 - BK ...YouTubeStart of suggested clipEnd of suggested clip How do I fill out the Adult Function Report (Form SSA - 3373 - BK ...

Describe what the disabled person does from time he/she wakes up until going to bed. Indicate whether the person takes care of another person. Indicate whether the person cares for other people or animals.

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 SSA-3380-BK
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