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Blank SSA SSA-3373-BK PDF Form

The SSA SSA-3373-BK form is a crucial document used by the Social Security Administration to assess an individual's ability to work due to disability. This form gathers detailed information about daily activities, medical conditions, and limitations that may affect a person's capacity to perform job-related tasks. Understanding how to accurately complete this form is essential for those seeking disability benefits, so take the first step by filling it out below.

Content Overview

The SSA-3373-BK form, also known as the Adult Function Report, plays a crucial role in the Social Security Administration's assessment of disability claims. This form is designed to gather detailed information about an individual's daily activities, capabilities, and limitations. Applicants are asked to provide insights into how their medical conditions affect their ability to perform routine tasks, engage in social interactions, and maintain personal care. The form covers various aspects of life, including physical activities, mental functioning, and the impact of the disability on work-related tasks. By detailing specific challenges faced in everyday situations, individuals can help the SSA understand the extent of their impairments. Completing this form accurately and thoroughly is essential, as it can significantly influence the outcome of a disability claim. The information provided not only aids in determining eligibility but also assists in identifying appropriate support services for those in need.

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Form SSA-3373 (02-2024) UF
Discontinue Prior Editions	Page 1 of 10
Social Security Administration	OMB No. 0960-0681

FUNCTION REPORT - ADULT

READ ALL OF THIS INFORMATION BEFORE

YOU BEGIN COMPLETING THIS FORM

IF YOU NEED HELP

If you need help with this form, complete as much of it as you can and call the phone number provided on the letter sent with the form, or contact the person who asked you to complete the form. If you need the address or phone number for the office that provided the form, you can get it by calling Social Security at 1-800-772-1213.

HOW TO COMPLETE THIS FORM

The information that you give us on this form will be used by the office that makes the disability decision on your disability claim. You can help them by completing as much of the form as you can.

It is important that you tell us about your activities and abilities.

•Print or type.

•DO NOT LEAVE ANSWERS BLANK. If you do not know the answer or the answer is "none" or "does not apply," please write "don't know" or "none" or "does not apply."

•Do not ask a doctor or hospital to complete this form.

•Be sure to explain an answer if the question asks for an explanation, or if you think you need to explain an answer.

•If more space is needed to answer any questions, use the "REMARKS" section on Page 10, and show the number of the question being answered.

•If a specific activity is performed with the help of others, please indicate that.

Function Report - Adult - Form SSA-3373-BK

REMEMBER TO GIVE US THE NAME AND ADDRESS OF THE PERSON

COMPLETING THIS FORM ON PAGE 10

Form SSA-3373 (02-2024) UF

Page 2 of 10

Privacy Act Statements

Collection and Use of Personal Information

Sections 205(a), 223(d), and 1631 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent an accurate and timely decision on any claim filed.

We will use the information you provide to determine benefits eligibility. We may also share the information for the following purposes, called routine uses:

•To third party contacts (e.g., employers and private pension plans) in situations where the party to be contacted has, or is expected to have, information relating to the individual's capability to manage his or her benefits or payments, or his or her eligibility for entitlement to benefits or eligibility for payments, under the Social Security program; and

•To contractors and other Federal agencies, as necessary, for the purpose of assisting the Social Security Administration (SSA) in the efficient administration of its programs. We will disclose information under this routine use only in situations in which we may enter into a contractual or similar agreement to obtain assistance in accomplishing an SSA function relating to this system record.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422, and 60-0320, entitled Electronic Disability Claim File, as published in the FR on June 6, 2020 at 85 FR 34477. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 61 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO

YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S.

Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments regarding this burden

estimate or any other aspect of this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to

our time estimate or other aspects of this collection to this address, not the completed form.

PLEASE REMOVE THIS SHEET BEFORE RETURNING

THE COMPLETED FORM.

Form SSA-3373 (02-2024) UF
Discontinue Prior Editions	Page 3 of 10
Social Security Administration	OMB No. 0960-0681

FUNCTION REPORT - ADULT

How your illnesses, injuries, or conditions limit your activities

For SSA Use Only

Do not write in this box.

Anyone who makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, commits a crime punishable under Federal law by fine, imprisonment, or both, and may be subject to administrative sanctions.

SECTION A - GENERAL INFORMATION

1. NAME OF DISABLED PERSON (First, Middle Initial, Last)

2. SOCIAL SECURITY NUMBER

3.YOUR DAYTIME TELEPHONE NUMBER (If there is no telephone number where you can be reached, please give us a daytime number where we can leave a message for you.)

Your Number

Message Number

None

Area Code Phone Number

4. a. Where do you live? (Check one.)

House	Apartment	Boarding House	Nursing Home
Shelter	Group Home	Other (What?)

b. With whom do you live? (Check one.)

Alone

With Family

With Friends

Other (Describe relationship.)

SECTION B - INFORMATION ABOUT YOUR ILLNESSES, INJURIES, OR CONDITIONS

5.How do your illnesses, injuries, or conditions limit your ability to work?

____________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 4 of 10

SECTION C - INFORMATION ABOUT DAILY ACTIVITIES

6.Describe what you do from the time you wake up until going to bed.

____________________________________________________________________________________________________


7. Do you take care of anyone else such as a wife/husband, children, grandchildren,	Yes	No
parents, friend, other?	Yes	No
parents, friend, other?
If "YES," for whom do you care, and what do you do for them?

8. Do you take care of pets or other animals?			Yes	No
If "YES," what do you do for them?

9. Does anyone help you care for other people or animals?
If "YES," who helps, and what do they do to help?			Yes	No

10.	What were you able to do before your illnesses, injuries, or conditions that you can't do now?

11.	Do the illnesses, injuries, or conditions affect your sleep?		Yes	No
If "YES," how?

12.	PERSONAL CARE (Check here	if NO PROBLEM with personal care.)
a. Explain how your illnesses, injuries, or conditions affect your ability to:
Dress

Bathe

Care for hair

Shave

Feed self

Use the toilet

Other

Form SSA-3373 (02-2024) UF		Page 5 of 10

b. Do you need any special reminders to take care of personal	Yes	No
needs and grooming?	Yes	No
If "YES," what type of help or reminders are needed?

__________________________________________________________________________________________________

c. Do you need help or reminders taking medicine?

Yes

If "YES," what kind of help do you need?

__________________________________________________________________________________________________

13. MEALS
a. Do you prepare your own meals?	Yes	No

If "Yes," what kind of food do you prepare? (For example, sandwiches, frozen dinners, or complete meals with several courses.)

__________________________________________________________________________________________________

How often do you prepare food or meals? (For example, daily, weekly, monthly.)

How long does it take you?

Any changes in cooking habits since the illness, injuries, or conditions began?

b. If "No," explain why you cannot or do not prepare meals.

__________________________________________________________________________________________________

14.HOUSE AND YARD WORK

a.List household chores, both indoors and outdoors, that you are able to do. (For example, cleaning, laundry, household repairs, ironing, mowing, etc.)

__________________________________________________________________________________________________

b. How much time does it take you, and how often do you do each of these things?

c. Do you need help or encouragement doing these things?	Yes	No
If "YES," what help is needed?

d. If you don't do house or yard work, explain why not.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 6 of 10

15.GETTING AROUND

a. How often do you go outside?

If you don't go out at all, explain why not.

__________________________________________________________________________________________________

b.	When going out, how do you travel? (Check all that apply.)
	Walk	Drive a car	Ride in a car	Ride a bicycle
	Use public transportation		Other (Explain)
c. When going out, can you go out alone?				Yes	No

If "NO," explain why you can't go out alone.

__________________________________________________________________________________________________

d. Do you drive?

Yes

If you don't drive, explain why not.

__________________________________________________________________________________________________

16.SHOPPING

a. If you do any shopping, do you shop: (Check all that apply.)

In stores

By phone

By mail

By computer

b. Describe what you shop for.

c. How often do you shop and how long does it take?

__________________________________________________________________________________________________


17. MONEY
a. Are you able to:
	Pay bills	Yes	No	Handle a savings account	Yes	No
	Count change	Yes	No	Use a checkbook/money orders	Yes	No
	Explain all "NO" answers.

b. Has your ability to handle money changed since the illnesses,					Yes	No
injuries, or conditions began?

If "YES," explain how the ability to handle money has changed.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 7 of 10

18.HOBBIES AND INTERESTS

a. What are your hobbies and interests? (For example, reading, watching TV, sewing, playing sports, etc.)

__________________________________________________________________________________________________

b. How often and how well do you do these things?

__________________________________________________________________________________________________

c. Describe any changes in these activities since the illnesses, injuries, or conditions began.

__________________________________________________________________________________________________

19.SOCIAL ACTIVITIES

a. How do you spend time with others? (Check all that apply.)

In person	On the phone	Email	Texting		Mail
Video Chat (for example Skype or Facetime)			Other (Explain)

b. Describe the kinds of things you do with others.

__________________________________________________________________________________________________

How often do you do these things?

c. List the places you go on a regular basis. (For example, church, community center, sports events, social groups, etc.)

__________________________________________________________________________________________________

Do you need to be reminded to go places?	Yes	No
How often do you go and how much do you take part?

Do you need someone to accompany you?	Yes	No

If "YES", explain.

__________________________________________________________________________________________________

d. Do you have any problems getting along with family, friends, neighbors, or others?	Yes	No
If "YES," explain.

__________________________________________________________________________________________________

e. Describe any changes in social activities since the illnesses, injuries, or conditions began.

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF

Page 8 of 10

SECTION D - INFORMATION ABOUT ABILITIES

20. a. Check any of the following items that your illnesses, injuries, or conditions affect:

Lifting	Walking	Stair Climbing	Understanding
Squatting	Sitting	Seeing	Following Instructions
Bending	Kneeling	Memory	Using Hands
Standing	Talking	Completing Tasks	Getting Along With Others
Reaching	Hearing	Concentration

Please explain how your illnesses, injuries, or conditions affect each of the items you checked. (For example, you can only lift [how many pounds], or you can only walk [how far])

__________________________________________________________________________________________________

b. Are you:

Right Handed?

Left Handed?

c. How far can you walk before needing to stop and rest?

If you have to rest, how long before you can resume walking?

__________________________________________________________________________________________________

d. For how long can you pay attention?


e. Do you finish what you start? (For example, a conversation, chores,	Yes	No
reading, watching a movie.)	Yes	No
reading, watching a movie.)

f. How well do you follow written instructions? (For example, a recipe.)

__________________________________________________________________________________________________

g. How well do you follow spoken instructions?

__________________________________________________________________________________________________

h. How well do you get along with authority figures? (For example, police, bosses, landlords or teachers.)

__________________________________________________________________________________________________

i. Have you ever been fired or laid off from a job because of problems getting	Yes	No
along with other people?

If "YES," please explain.

__________________________________________________________________________________________________

If "YES," please give name of employer.

Form SSA-3373 (02-2024) UF

Page 9 of 10

j. How well do you handle stress?

k. How well do you handle changes in routine?

l. Have you noticed any unusual behavior or fears?

Yes

If "YES," please explain.

__________________________________________________________________________________________________

21. Do you use any of the following? (Check all that apply.)
Crutches	Cane	Hearing Aid
Walker	Brace/Splint	Glasses/Contact Lenses
Wheelchair	Artificial Limb	Artificial Voice Box
Other (Explain)

Which of these were prescribed by a doctor?

__________________________________________________________________________________________________

When was it prescribed?

__________________________________________________________________________________________________

When do you need to use these aids?

__________________________________________________________________________________________________

Form SSA-3373 (02-2024) UF		Page 10 of 10

22. Do you currently take any medicines for your illnesses, injuries, or conditions?	Yes	No
If "YES, "do any of your medicines cause side effects?	Yes	No

If "YES," please explain. (Do not list all of the medicines that you take. List only the medicines that cause side effects.)

NAME OF MEDICINE

SIDE EFFECTS YOU HAVE

SECTION E - REMARKS

Use this section for any added information you did not show in earlier parts of this form. When you are done with this section (or if you didn't have anything to add), be sure to complete the fields at the bottom of this page.

______________________________________________________________________________________________________

Name of person completing this form (Please print)

Date (MM/DD/YYYY)

Address (Number and Street)

Email address (optional)

City

State

ZIP Code

➤ PDF File

Form Specifications

Fact Name	Description
Purpose	The SSA-3373-BK form is used by the Social Security Administration to evaluate a claimant's ability to work due to a mental condition.
Target Audience	This form is intended for individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Sections	The form includes sections that ask about daily activities, social functioning, and concentration abilities.
Submission Method	Applicants can submit the form online, by mail, or in person at their local Social Security office.
Required Information	Claimants must provide detailed information about their mental health history, treatment, and how their condition affects their daily life.
Supporting Documents	It is recommended to attach any relevant medical records or reports from healthcare providers to support the application.
State-Specific Forms	Some states may have additional forms or requirements based on local laws. Check with your state's Social Security office for details.
Review Process	The completed form is reviewed by Social Security representatives, who may request additional information or clarification if needed.

SSA SSA-3373-BK: Usage Guidelines

Completing the SSA-3373-BK form is an important step in the process of applying for Social Security benefits. This form gathers information about your daily activities and how your condition affects your ability to function. To ensure that your application is complete and accurate, follow these steps carefully.

Start by downloading the SSA-3373-BK form from the Social Security Administration’s website or obtain a physical copy from your local office.
Read the instructions at the top of the form. Familiarize yourself with the sections to understand what information is required.
Fill in your personal information in the designated areas, including your name, Social Security number, and contact information.
Provide detailed information about your medical condition. Describe how it limits your daily activities and any treatments you are currently receiving.
Document your daily routine. Outline a typical day, including how your condition affects your ability to perform tasks such as cooking, cleaning, and socializing.
List any medications you take, including dosages and how they affect your daily life.
Include information about any healthcare providers you see. This should include their names, addresses, and the nature of your relationship with them.
Review your completed form for accuracy. Make sure all sections are filled out and that there are no missing details.
Sign and date the form at the bottom. This confirms that the information you provided is true and complete to the best of your knowledge.
Submit the form either online, if applicable, or by mailing it to the appropriate Social Security office as indicated in the instructions.

After submitting the SSA-3373-BK form, you may need to wait for a response from the Social Security Administration. Be prepared to provide additional information if requested, and keep a copy of your completed form for your records. This will help you track your application and ensure that you can address any follow-up questions that may arise.

Your Questions, Answered

What is the SSA SSA-3373-BK form?

The SSA SSA-3373-BK form, also known as the Adult Function Report, is a document used by the Social Security Administration (SSA). It helps the SSA assess how a person's disability affects their daily life and ability to work. Claimants provide detailed information about their activities, limitations, and challenges they face due to their condition.

Who needs to fill out the SSA SSA-3373-BK form?

This form is typically required from individuals applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). If you have a medical condition that significantly impairs your ability to perform daily tasks or work, you may need to complete this form as part of your application process.

How do I complete the SSA SSA-3373-BK form?

To complete the form, you will need to provide detailed answers about your daily activities, personal care, social interactions, and any hobbies or interests. It is essential to be honest and thorough, as the information will be used to evaluate your claim. Take your time to think about how your condition impacts various aspects of your life.

Where can I obtain the SSA SSA-3373-BK form?

You can download the SSA SSA-3373-BK form directly from the Social Security Administration's website. Alternatively, you can request a paper copy from your local SSA office. Make sure you are using the most current version of the form to avoid any processing delays.

What happens after I submit the SSA SSA-3373-BK form?

Once you submit the form, the SSA will review your responses along with your medical records and other evidence. This information will help them determine your eligibility for disability benefits. You may be contacted for additional information or clarification if needed.

Can I get help filling out the SSA SSA-3373-BK form?

Yes, you can seek assistance from various sources. Friends, family members, or professionals experienced in disability claims can help you complete the form. Additionally, organizations that advocate for people with disabilities may offer guidance and resources to ensure your application is as strong as possible.

Is there a deadline for submitting the SSA SSA-3373-BK form?

While there is no specific deadline for submitting the form itself, it is crucial to submit it as part of your overall disability application within the designated timeframe set by the SSA. Delays in submitting the form could slow down the processing of your claim.

What if I make a mistake on the SSA SSA-3373-BK form?

If you realize you made a mistake after submitting the form, you can contact the SSA to correct the information. It is important to provide accurate details, as discrepancies could affect the outcome of your claim. Always keep a copy of your submitted form for your records.

Common mistakes

Not providing complete information: Many individuals leave sections blank or fail to provide all necessary details. Each question is important for assessing your claim.
Inconsistent answers: Providing conflicting information can raise red flags. Ensure that your responses align with other documentation you submit.
Failure to explain limitations: Simply stating you have a condition is not enough. Describe how your condition affects daily activities and your ability to work.
Neglecting to mention all medical conditions: It’s crucial to list all physical and mental health issues. Overlooking any condition can weaken your case.
Ignoring the importance of supporting documents: Attach relevant medical records and other documentation. These materials can substantiate your claims.
Not updating information: If your condition changes, update your application. This ensures that the SSA has the most current information.
Rushing through the form: Take your time when filling out the SSA-3373-BK. Careful consideration can prevent mistakes that might delay your application.
Failing to sign and date the form: A missing signature or date can result in your application being returned. Always double-check before submitting.
Not seeking help when needed: If you're unsure about how to fill out the form, don’t hesitate to ask for assistance. There are resources available to help you.

Documents used along the form

The SSA SSA-3373-BK form, also known as the Function Report, is essential for individuals applying for Social Security Disability benefits. It provides detailed information about how a person's disability affects their daily life. Along with this form, several other documents can support the application process. Here’s a list of commonly used forms and documents that may accompany the SSA-3373-BK form:

SSA-16 (Application for Disability Insurance Benefits): This form is used to apply for Social Security Disability Insurance (SSDI) benefits. It collects personal information, work history, and details about the applicant's disability.
SSA-827 (Authorization to Disclose Information to the Social Security Administration): This document allows the SSA to obtain medical records and other relevant information from healthcare providers and institutions.
SSA-3368 (Adult Function Report): Similar to the SSA-3373-BK, this form focuses on the applicant's functional abilities and limitations, providing further insight into their daily activities.
Medical Records: Comprehensive medical records from healthcare providers help establish the severity of the disability. These records may include diagnosis, treatment history, and any relevant test results.
Work History Report: This document outlines the applicant’s past employment, detailing job duties, skills, and how the disability has impacted their ability to work.
Educational Records: For younger applicants or those who have received specialized training, educational records can provide context about their learning capabilities and any accommodations received.
Statements from Friends and Family: Personal testimonials from those who know the applicant well can support claims about how the disability affects daily life and social interactions.
Vocational Assessment: A report from a vocational expert can evaluate the applicant's ability to work and assess potential job options considering their limitations.

Gathering these documents can significantly enhance the chances of a successful application for disability benefits. Each form and record plays a vital role in providing a comprehensive view of the applicant's situation, ensuring that the SSA has all the necessary information to make an informed decision.

Similar forms

The SSA-3373-BK form is used by the Social Security Administration to gather information about an individual's daily activities and how their condition affects their ability to function. Several other documents serve similar purposes in assessing an individual's health and limitations. Here are five such documents:

SSA-3368-BK: This form, known as the Disability Report - Adult, collects detailed information about the applicant's medical history, work history, and daily activities. Like the SSA-3373-BK, it aims to understand how a disability impacts a person's life.
Form 827: The Authorization to Disclose Information to the Social Security Administration allows individuals to authorize others to share their medical information with the SSA. This document supports the information provided in the SSA-3373-BK by ensuring the SSA has access to relevant medical records.
Form SSA-3820: The Work History Report gathers information about an individual's past employment and how their disability has affected their work capabilities. It complements the SSA-3373-BK by providing a broader context of the applicant's work history.
Form SSA-8006: The Function Report - Adult is similar to the SSA-3373-BK in that it focuses on daily activities and limitations. It asks specific questions about how a person's condition affects their ability to perform tasks at home, work, and in social situations.
Form SSA-831: The Disability Determination Explanation outlines the reasoning behind the SSA's decision on a disability claim. It references the information provided in the SSA-3373-BK, explaining how the individual's reported limitations influenced the final determination.

Dos and Don'ts

When filling out the SSA SSA-3373-BK form, it’s important to follow specific guidelines to ensure your application is processed smoothly. Here are nine things you should and shouldn't do:

Do read the instructions carefully before starting.
Don't leave any sections blank; provide answers to all questions.
Do use clear and concise language to describe your condition.
Don't exaggerate or downplay your symptoms; be honest.
Do provide specific examples of how your condition affects daily activities.
Don't submit the form without reviewing it for errors.
Do keep a copy of the completed form for your records.
Don't forget to sign and date the form before submitting.
Do follow up with the SSA if you do not receive confirmation of your application.

Misconceptions

The SSA SSA-3373-BK form, also known as the Function Report, is an important document used by the Social Security Administration (SSA) to evaluate an individual's ability to work. However, there are several misconceptions surrounding this form that can lead to confusion. Below is a list of common misunderstandings about the SSA-3373-BK form:

It's only for physical disabilities. Many believe that this form is solely for individuals with physical impairments. In reality, it is used for both physical and mental health conditions, assessing how these issues affect daily functioning.
Completing the form is optional. Some people think that filling out the SSA-3373-BK is not mandatory. However, this form is a crucial part of the application process for disability benefits, and providing complete information is essential.
Only medical professionals can fill it out. There is a misconception that only doctors or therapists can complete this form. While medical input is valuable, individuals can and should provide their own insights about their daily activities and limitations.
It only needs to be filled out once. Many assume that the form only needs to be submitted during the initial application. In fact, it may need to be updated or resubmitted if there are changes in the individual’s condition or circumstances.
It’s not important for the decision-making process. Some believe that this form does not significantly impact the SSA's decision. On the contrary, the information provided is often critical in determining eligibility for benefits.
All questions must be answered in detail. While providing detailed answers is helpful, some may feel overwhelmed by the need for extensive information. It is important to answer questions to the best of one's ability without the pressure to be exhaustive.
The SSA-3373-BK is the only form needed. Lastly, there is a misconception that this form alone suffices for a complete application. However, additional documentation and forms may be required to support the application for disability benefits.

Understanding these misconceptions can help individuals approach the SSA-3373-BK form with clarity and confidence. It is essential to provide accurate information to ensure a fair evaluation of one’s situation.

Key takeaways

Filling out the SSA SSA-3373-BK form can be an important step for individuals seeking Social Security disability benefits. Here are some key takeaways to keep in mind:

Understand the Purpose: This form is used to provide detailed information about your daily activities and how your condition affects your ability to work.
Be Thorough: Include as much information as possible. The more details you provide, the better the Social Security Administration can understand your situation.
Use Clear Language: Write in simple, straightforward terms. Avoid jargon or technical language that might confuse the reader.
Review Before Submission: Double-check your answers for accuracy. Mistakes can lead to delays or denials of your application.
Seek Assistance if Needed: If you find the form challenging, consider asking a friend, family member, or professional for help in completing it.

Completing the SSA-3373-BK form accurately can significantly impact your application process. Take your time and provide a clear picture of your circumstances.