FUNCTION REPORT - ADULT Page 1 of 10 OMB No. 0960-0681 READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need help with this …
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About Forms All forms are free. If you cannot find the form you need or require assistance completing the form, please go to the Contact Us link. Submitting Forms and Supporting Documents You can …
SSA - POMS: DI 11005.016 - Forms Used in Title II & Title XVI ...
Jul 26, 2017 · The SSA-3373 records information about a claimant's ability to function and to perform the activities of daily living, in the circumstances listed in DI 11005.026.
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Gather your documents, including any Social Security forms you filled out. Then, find your local Social Security office and submit them by fax, by mail, or using your office’s drop box.
SSA - POMS: DI 11005.026 - Completing the SSA-3373-BK (Function …
Jun 20, 2007 · Use the SSA-3373 to collect information about a claimant's ability to function and to perform the activities of daily living.The information detailed on the SSA-3373 may be obtained by …
The purpose of the function report is for the applicant to provide information about his/her abilities. The information furnished will be provided to the Disability Determination Services. To ensure questions …
Form SSA-3368-BK (06-2024) UF Discontinue Prior Editions Page 1 of 15 Social Security Administration OMB No. 0960-0579
FUNCTION REPORT - ADULT - THIRD PARTY Form SSA-3380-BK READ ALL OF THIS INFORMATION BEFORE YOU BEGIN COMPLETING THIS FORM IF YOU NEED HELP If you need …
AFTER COMPLETING THIS REPORT, REMOVE THIS SHEET AND KEEP IT FOR YOUR RECORDS Form SSA-3369-BK (06-2024) UF Discontinue Prior Editions Page 3 of 14 Social Security …
The information that you give us on this form will be used by the office that makes the disability decision on the child's claim. You can help them by completing as much of the form as you can.