Form SSA-3373-BK: How to report your disability conditions to the SSA

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Form SSA-3373-BK, Function Report – Adult

Today’s review is devoted to one of the most important documents when applying for Social Security benefits – Form SSA-3373-BK, Function Report – Adult. This form is the main source of general information for the SSA (Social Security Administration) on each particular application case. Let’s take a closer look at how the Function Report should be completed.

Who needs an SSA-3373-BK Form?

Disabled individuals are required to submit an SSA-3373 Form, also called a Function Report, when they need to file a claim for disability benefits. This form is of extreme importance when applying for Social Security Disability.

What is SSA-3373-BK for?

The 3373-BK Form is designed to help the Social Security Administration analyze disability cases and make decisions whether the SSDI should be paid to persons who are unable to work. A submitter should complete as much of the form as they can.

The questions of the form cover the following issues:

  • how the claimant’s physical condition limits his/her work;
  • the claimant’s regular daily and specific activities;
  • basic abilities;
  • medication and side effects, etc.

Is the SSA-3373-BK accompanied by other forms?

To make a decision, the SSA usually requires the following information about the claimant and the case:

  • Social Security Number (provided by the claimant);
  • birth certificate (provided by the claimant);
  • medical information and diagnosis (confirmed by the medical institution the claimant addressed); and
  • work information (provided by the employer).

When is the SSA-3373-BK due?

It is necessary to apply to the SSDI in case the claimant’s impairment is expected to last for at least 12 months or to result in death.

How do I fill out SSA-3373-BK?

Do not ask a doctor or a hospital to complete this form for you. If there is a chance that the SSA won’t understand the handwriting due to its illegibility, it is advisable to ask a trusted person for help.

None of the questions must be left unanswered, and they all should provide relevant and detailed information. The “Remarks” section must be used if more space is needed to answer any question of this form.

The following sections of the form must be completed:

  1. Section A – General Information;
  2. Section B – Information About Your Illness, Injuries, or Conditions;
  3. Section C – Information About Daily Activities; and
  4. Section D – Information About Abilities.

Where do I send SSA-3373-BK?

The completed SSA Form 3373 must be submitted to the Social Security Administration office that requested it. If you do not know the address, you may call Social Security at 1-800-772-1213.