SSA 3373 Template

[toc] When you complete an application for disability benefits from Social Security, there are a number of different forms you’ll need to address. After all of the information has been collected through your local office, the paperwork is sent to whatever state agency is responsible for further action. You might be required to fill out an Adult Function Report at the reconsideration level, the initial filing level, or at both points.

The Function report is a normal part of a disability application with the Social Security administration. You’ll be asked to answer a series of questions about your disability and how it impacts your day-to-day functioning. Many attorneys advise double checking with them before you submit the form. This is the form used to prove that you are not capable of holding a full-time job, otherwise known as working 8 hours a day, 5 days a week.

The report covers 8 pages, which can seem intimidating. It’s important to understand how to fill it out and what information is important. This information will have a great impact on whether your disability claim is approved.

If you need help completing the form, the best thing is to complete as much as you’re able to. Then, call the phone number of the Social Security office. They will walk you through how to complete the other sections of the form.

Even though this form is long, most of the information it requires is fairly straightforward. You should make sure to include explanations for all questions that ask for them. If you need extra space, you should use the “Remarks” section noted on Page 8. Make sure you write the number of the question that you’re answering.

This type of form will generally be filled by any person who’s making a disability claim through the Social Security office. You might be asked to fill this form during the initial claims process. You may also be asked to fill it out again if your application is being reconsidered after an initial rejection.

When you first file your claim, your local Social Security office will tell you what paperwork they require. This office is in charge of gathering your required paperwork into a file. When the file is complete, it will be sent to the state for consideration. They’ll walk you through every step of the process.

You should fill out a Function form if the office asks you to. It may be part of your required paperwork.

If you fail to fill out the form when you’re required to, you might not have your disability application submitted. If you’re working on a reconsideration of a previously-submitted application, failing to fill out the form could result in the reconsideration being dropped.

Section A will record general information about you. You’ll need to note your full name, SSN, and the daytime telephone number at which you can be reached. If you don’t have a phone number at which you can be reached, you’ll need to provide a number at which a message can be left for you. Check what type of residence you currently live in, along with an indication of whether you live with anybody else.

Section B asks for information about your conditions, injuries, and illnesses. You’ll need to describe your limitations. Make sure you include information about the number of hours you can be active per day, any physical mobility issues, and the impact on your day-to-day life. You’ll then describe what a typical day is like for you, from waking up to going to bed.

These answers are followed by a series of yes or no questions about your living situation. They’ll include whether you care for anyone, care for pets, or receive help to care for people or pets. You should provide explanations for each of your answers.

In the personal care section, you’ll have to describe ways in which the disability affects your capability to take care of yourself. You’ll then have to give information about your meals, including the kinds of food you prepare and how often you prepare food.

Question 14 will have you talk about the household chores you do inside and outside of the house. Question 15 will ask about your ability to get around. You’ll be asked to note the frequency with which you go outside, whether you travel at all, and whether you can drive.

You’ll be asked to explain where you shop and what you shop for, along with the frequency that shopping trips occur. Under “Money,” you’ll have to fill out several check boxes explaining whether you have the ability to handle certain tasks. If any of the answers are “NO,” you’ll need to explain.

You’ll need to write about your hobbies, interests, and social activities. These include the frequency with which you participate in these things, along with any changes that have occurred since you became disabled.

Section D will record information about your capabilities. You’ll need to put a check mark by any listed items that your disability affects. For any checked item, you’ll need to provide an explanation. You’ll also need to check whether you use any mobility assistive devices such as crutches, a cane, a wheelchair, or a hearing aid.

You need to list any medications that you take, along with any side effects that the medications give yu.

Section E is the Remarks section. If there was any point at which you needed to add more information, but you didn’t have enough room, you should use Section E to do so. Make sure you indicate which question you’re answering.

Type your name, the date, your address, and email address.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/ssa-3373.pdf”]