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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....

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Related content

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

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© 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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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